Comparison of the postoperative opioid-sparing effect between preemptive and preventive intravenous acetaminophen/ibuprofen fixeddose combination in patients undergoing robotassisted laparoscopic radical prostatectomy: a double-blind randomized controlled trial Soo-Hyuk

Background: Inadequate pain control after robot-assisted laparoscopic radical prostatectomy (RALP) can impair recovery and quality of life. The acetaminophen/ibuprofen combination is a useful component of opioid-sparing analgesia, but the optimal timing of administration remains unclear. This study aimed to compare preemptive and preventive administration of this combination in RALP patients. Methods: Adult patients undergoing RALP under general anesthesia were enrolled. Patients were randomized in a 1:1 ratio to receive acetaminophen 1,000 mg and ibuprofen 300 mg in 100 mL solution either before incision (preemptive group) or at the end of surgery (preventive group). The primary outcome was cumulative fentanyl consumption via intravenous patient-controlled analgesia within 24 postoperative hours. Postoperative pain intensity was assessed using the 11-point numeric rating scale and the Korean version of the Quality of Recovery-15 questionnaire (QoR-15K), and postoperative liver and renal function tests, were evaluated. Results: Of 154 patients enrolled, 152 were included in the final analysis. Cumulative fentanyl consumption within 24 hours did not differ significantly between the preemptive and preventive groups (260 μg vs. 320 μg; median difference –60 μg (95% confidence interval [CI] –140 to 60), P = 0.409). Pain scores were generally comparable, but at 48 hours postoperatively the preemptive group showed lower scores (median difference –1.0 [95% CI –1.0 to 0.0], P = 0.040). Opioid use at other time points, QoR-15K scores, and laboratory tests showed no significant differences between the groups. Conclusions: Postoperative opioid consumption was not significantly different between preemptive and preventive administration of acetaminophen/ibuprofen in patients undergoing RALP.