IV Ibuprofen: The Gold Standard for Perioperative Pain?
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- Опубліковано 6 вер 2023
- Discover the top 8 reasons why IV Ibuprofen should be your go-to choice for perioperative analgesia, especially for orthopedic surgery patients. Dive into the benefits of a seamless transition from IV to oral ibuprofen and the perks of avoiding polypharmacy. Despite its global presence and proven effectiveness, find out why IV Ibuprofen remains overlooked by many. Time to re-evaluate its place in our practices!
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's UA-cam channel is accurate.
In the UK where I've worked we have IV ketorolac and parecoxib. Probably a matter of price. Don't see a reason why we shouldn't administer the most safe and effective analgesics we can. Using more powerful versions of every day medications in the perioperative period doesn't seem like polypharmacy to me.
Quite suspicious of this video to be honest. Any conflicts of interest to declare?
Also - it's a class effect with NSAIDs. Theres no polypharmacy if you use one NSAID intraoperatively and then discharged home with another NSAID. I don't understand the point of this video and agree, it raises suspicion for COI.
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Weird one. Feels like an advert
Can you explain further the risks of polypharmacy transitioning from one NSAID to another? Also, the synergistic effect paper you're showing (#4) has no confidence intervals, which likely means the authors chose not to include these in their figure as it isn't significant. Just checked the paper and my hunch was correct.
Last point.. COST $200/unit vs $2/unit from a quick google search
It all depends on how you need to make people believe in you, choose the words. If you want to show it's good call it balanced or multimodal. Otherwise call it polypharmacy. Words are mightier than the needle.
my thought exactly..
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Great video Dr! Thank you
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We use IV Dexketoprofen + paracetamol + metamizol (so useful in urologic and laparoscopic surgeries due to spams reliever properties) intraoperatively and post discharge we switch to just Dexketoprofen + paracetamol on oral form, which currently is way cheaper and more effective than just IV ibuprofen + paracetamol.
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I agree with you! This is something we should consider.
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Thank you 🙏
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What about the costs? When I look at the supplier for my business, my cost for 25 vials of ketorolac is $64.87 while 25 vials of ibuprofen is $823.84. Care to disclose what the contract is at your institution?
Gabriel Lane, MD
HI Gabriel - where do you practice? That seems excessive - it looks like $32/dose? I will get back to you once I check the numbers in USA/EU where I worked. Best and thanks for watching!
In the USA, perhaps the costs are different in EU (they usually are, health care/pricing is a little messed up here).
That is also my cost through my personal business, I didn’t ask the pharmacies at the hospitals I work at what their costs might be, sometimes they have significantly better pricing due to volume. But I thought that the IV formulation in the US was still largely produced by one manufacturer, which usually results in inflated costs.
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There is also a po form toradol. By the same token, can one say continue po toradol after discharge is the same?
This seems to make the whole process easier from the patient's perspective too. 🥳
Indeed!
How is this any easier for the patient?? They are not dosing themselves in the hospital with either IV NSAID. The dosage, route, & frequency will likely change when they discharge home, regardless of which drug was used in the hospital.
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I have never seen IV ibuprofen in all the countries I work in currently - South Africa and Ireland. In South Africa, we use iv parecoxib 40 mg or lornoxicam 8mg (Xefo) for several years already. Post-op, usually give Xefo orally. NSAIDs do not cause higher intra-op bleeding.
Thank you. Agree - with the bleeding comment - I do not know where that concern cames from. I also did not know that IV Iburpofene was available at all, actually. Which is what inspired me to produce this video. Greetings and thanks for watching! And what do you transition your patients to ORAL NSAIDS postoperatively?
in middleeurope they dont use IBU i.v. they use "novalgin" active ingredient Metamizol i.v., sometimes they use "Perfalgan" PCM 1gramm i.v. but not all hospitals
Agree) I started using combination of IV ibuprofen and paracetamol when it become available
Great to hear - thank you for sharing. Where do you practice? Greetings!
@@nysoravideo Greetings)💛💙 Ukraine
@@maidenn7959 We appreciate all your fantastic comments and support! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is the answer. Try it free for 7 days and let us know what you think. Let's conquer IV access together! www.nysora.com/iv-access-app/
In Germany we routinely use metamizol for postoperative analgesia with or without added opioids. At our hospital iv ibuprofen is available as well, but risks compared to metamizol are actually higher, for example concerning cardiovascular complications or gastric ulcera. But metamizol is not available outside of Germany i guess?
Metamizol is outstanding. What are is cost in Germany? Indeed. Many thanks for watching and best regards!
In Poland Metamizol is widely used ;) We have ibuprofen avaiable i.v. too. I like to use metamizol + nsaids (like dexketoprofen/ibuprofen)
@@nysoravideoit‘s about 19€ ($20) for 10 vials of 1 g Metamizol. So under 2€ per dose. I have not seen IV Ibuprofen at my institution yet but I hope we‘ll get it soon.
@@Pacula251 Thank you for your comments and support! If you or your nurses or colleagues are struggling with IV access, the new NYSORA IV Access App can make it easier. Enjoy a 7-day free trial and share your experience with us. Together, we'll become IV access pros! www.nysora.com/iv-access-app/
a few years ago i raised a similar question in a different environment about the use of iv panadol, the reply boiled down to cost on a background of we've always done it the other way... when ordering the drug it was made so difficult in comparison with its cheaper alternative and this wasnt even in a private hospital. Shame that the cost of iv ibuprofen vs the cost of its alternatives werent mentioned, especially at the moment, its not about the patient
Indeed. It would be good to dig deeper into why it is more expensive like that! What are the costs in your cospital? Many thanks for watching and best regards!
@@nysoravideo yes indeed, in my current hospital cost comes first, care... hmm ... I enjoy all the nysora videos
@@juki6377 We truly appreciate your comments and support! If you or your nurses or colleagues are struggling with IV access, the new NYSORA IV Access App can help. Enjoy a 7-day free trial and let us know how it goes. Together, we'll excel in IV access! www.nysora.com/iv-access-app/
We are limited to how many doses of IV Tylenol we can give where I work because of the price of it. I wonder if that is the case with ibuprofen as well, maybe it’s a price issue?
Indeed. What is the price of IV Tylenol in your hospital?
Thank you for all your comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/
@@nysoravideo I’ve heard it’s about $1k a dose for IV Tylenol..
I know you do more stuff on teaching and education which I love even though I am not a doctor but I would really like your educated opinion regarding sedating patients who are not ready and are alert and the doctor knows in advance that the process must be slow. If the doctor who is giving the anesthesia knows all of this information and agrees to it but once you are in the O.R. he doesn't follow what he promised. Isn't the doctor now becoming unethical and you are not able to trust him to put you to sleep. The doctor puts you down without knowledge and you wake up with flashbacks of what they did to you have developed PTSD from their behavior. What do you think?
Huhuh! This is a tough one, and probably a question that require deep dive into what exactly happened, etc in order to provide a meaningful feedback! Indeed. It would be good to dig deeper into why it is more expensive like that! Many thanks for watching and best regards!
@@nysoravideo I know that in emergency cases it has to be done to save the life of the patient. But in an elective case where the doctor knows you are a patient that suffers from PTSD ahead of time and the patient tells you not to sedate you until they feel comfortable and they agree to this prior to surgery and the surgeon has informed the anesthesia doctor too and he agrees. Then he should follow that. But it instead the doctor started yelling at trying to force me to put the mask on my face I told him to wait a minute and I was still trying to communicate with him but he was not going to hear it. He just sedated me without my knowledge and because of what he did caused PTSD flashbacks. Later I had an FND attack because of aggressive behavior. I wish you would do a video about how anesthesiologists should treat patients properly. How can you trust a doctor if he is yelling at you or they are scaring you? They are there to keep you alive. I ended up reporting that the doctor there no excuse to give me 30 seconds to get myself ready for surgery or let me it was time to sleep. I wish you would do a teaching video for doctors who watch around the world about how to be kind to patients who suffer from mental illness or are nervous or scared.
How much extra are you paying the hospital for your prolonged use of the OR while you wait to feel comfortable???! Ask for an oral sedative in advance. Operating rooms & medical staff are on a tight schedule. We don’t have time to wait. Every second of delay costs money and puts other patients and staff behind.
@@TubnQT 30 seconds what I am talking about. Staff can wait 30-60 seconds. I am lucky that I have understanding team. I Think problem is that staff tend to treat people as meat bags and hurry long because that is what they suppose to do and they forget about the patient who has probably never had surgery before or they are having cancer surgery! Where is they kindness and understanding for each patient!!! When patient goes in for surgery the last thing you should be think about is the MONEY!!!! That is your job to keep patient comfortable and be understanding I am talking about 45 minute time frame I talking about a minute of time so the patient prepared. I don't want be knocked out before seeing the OR. I actually like meeting the team and thank them for their time. I used to be firefighter many years ago and would never disrepect my patients. It sounds like you don't like your job if you this way. I feel sorry for anyone that would to deal with your attitude.
what about diclofenac vs ibuprofen?
Good question DBH! I do not have clinical experience on this, though Ibuprophene is the most widely used NSAIDS. Have you used Diclofenac IV? Please leave your reply below and we all learn something new! Best regards and thank you for watching.
In India,diclofenac iv/IM -both formulations are available & commonly used.
I have never heard of anyone using an NSAID intraoperatively due to higher risk of bleeding.
And isn’t ketorolac stronger than ibuprofen?
Using or not using? Everyone gets an nsaid these days, pre, intra or post op.
@@nicolascrescimone what country do you work? In the US ketorolac is saved until postop or at end of procedure if the procedure is likely to produce any bleeding
@@Eman1900O same country, it's a myth that NSAID increase intraop bleeding, there are several studies that show that. The only ones that don't want it are some spine surgeons because they believe it affects the fusions and some neurosurgeon when they do brain surgeries. When I used to have IV ibuprofen I would always start it after induction. Plus we give all sort of NSAIDs as part as ERAS protocols pre-op.
@@nicolascrescimone interesting. I’ll have to look up those studies. Thank you
Hi @@Eman1900O. Thank you for the comment. Do you really believe that intraoperative vs Postoperative administration makes a difference? Please leave your reply below and we all learn something new! Best regards and thank you for watching.
Yo, please disclose if this is a sponsored video!
dipyrone!
What dose! Best regards
@@nysoravideo Dipyrone is the most commonly prescribed NSAID in Brazil, its widespread use makes hard to find a single brazilian that had never took dipyrone multiple times. In the context of anesthesia it is used at IV doses of 30mg/kg and post op oral doses of 1g usualy 4 times at day. I find shocking its prohibited prescription in several countries
@@AJoeshful In Ukraine we also using metamisole 1 g × 3 - 4 times per day, sometines old scool combination with Diphenhydramine🙃) . And as I mentioned above me started using IV ibuprofen + paracetamol for postop analgesia.
P.S. As I felt for my migraine headache relief (1 gramm of metamisole PO is eqivalent in my case 1 gramm paracetamol PO + 400 mg ibuprofen PO combination. But it's only observation made by myself😄😁)
As it has settled in my concepts, dipyrone is way closer to paracetamol, than to other NSAIDs - more central effects, than peripheric anti-inflammatory action. Very useful drug, both IV and per os, but not exactly a substitute for ibuprofen. IMHO, it suits more as an additive to it
@@rambam111 agree 100%
Idk. I get the concept, but they're the same class, so...
How do you feel about an anesthesia doctor sedating a patient in elective surgery and the patient completely alert? The doctor decides to sedate the patient without their knowledge and the patient wakes up later with serve PTSD because of what they did. Do you think this is wrong for that doctor to do this without discussing this with the patient or warning them first?
@lindadove8298 Sooooo….you want us to sedate you before we sedate you?
@@TubnQT no I am I was sedated without my knowledge while I speaking to the doctor. Not prepared because he did not tell me it caused me PTSD when I woke up.
Just give PO ibuprofen preop then. Problem solved.