Efficacy and Safety of Multimodal Analgesia in Bariatric Surgery: Comparison of Ketorolac and Ibuprofen

BACKGROUND: Adequate postoperative analgesia following laparoscopic bariatric resection is a key factor in promoting rapid recovery and reducing the risk of complications. Comparing the nonsteroidal anti‑inflammatory drugs ibuprofen and ketorolac within a multimodal analgesia regimen is important for optimizing perioperative pain management.

AIM: To compare the efficacy and safety of perioperative analgesia with ibuprofen versus ketorolac as part of a multimodal approach in patients undergoing elective bariatric surgery.

METHODS: This prospective analysis included 90 patients allocated to the ibuprofen group (n=45) and the ketorolac group (n=45). The primary outcome was pain intensity measured by the Visual Analog Scale (VAS) at rest and during movement at 0.5, 2, 4, 6, 12, and 24 hours postoperatively. Secondary outcomes comprised time to first analgesic request, need for rescue analgesia, gastrointestinal recovery (time to first flatus), time to ambulation, quality of recovery assessed by the QoR‑15 questionnaire, and incidence of adverse events. Statistical analyses included the Student’s t‑test or Mann–Whitney U test for continuous variables and Fisher’s exact test for categorical variables.

RESULTS: The two groups were comparable in terms of age, body mass index, ASA status, and duration of surgery (p >0.05). At rest, ibuprofen demonstrated significantly lower VAS scores at 4 hours (median 32 vs. 37 mm; p=0.0004) and 12 hours (29 vs. 36 mm; p=0.020). During movement, significant differences favoring ibuprofen were observed at 4 hours (35 vs. 44 mm; p=0.0002) and 12 hours (33 vs. 45 mm; p=0.0097). The frequency of rescue analgesia was lower in the ibuprofen group (26.7% vs. 46.7%; p=0.049), and time to first analgesic dose was longer (median 124 vs. 72 minutes; p=0.008). Gastrointestinal recovery occurred sooner with ibuprofen (15 vs. 23 hours; p <0.0001), and QoR‑15 scores were higher at 48 and 72 hours (p=0.0002; p <0.0001). Adverse event rates were low and did not differ significantly between groups; postoperative bleeding was noted only in the ketorolac group (4.4% vs. 0%; p=0.494).

CONCLUSION: Preventive administration of ibuprofen within a multimodal analgesia protocol provides earlier and more pronounced pain relief, decreases the need for rescue analgesia, and accelerates recovery of gastrointestinal function and overall well‑being without increasing the risk of complications compared with ketorolac.