Prospective Evaluation of the Analgesic Efficacy and Emetogenic Profile of Intravenous Ibuprofen and Metamizole in the Immediate Postoperative Period of Pediatric Acute Appendicitis

Abstract BACKGROUND Literature comparing different alternatives for pain control in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce. METHODS We conducted a prospective study to compare the analgesic and emetogenic profile of ibuprofen and metamizole in the postoperative period of PAA in a sample of children operated on in 2021 in our center. Participants were recruited on arrival at the Emergency Department and histopathological confirmation of the diagnosis was obtained in all of them. Pain was evaluated every 8 hours after the surgery with validated visual analog scales ranging from 0 to 10 points. Repeated measures ANOVA was used to compare the evolution of pain in the 48 hours after surgery between the two groups. RESULTS The sample included 95 patients (65% males) with a mean age of 9.7 years (sd: 3.14). 41 patients were treated with Ibuprofen (group 1) and 54 with metamizole (group 2). No significant differences were found in the level of pain either in the comparisons of point measurements or in its evolution in the 48 hours after surgery (p = 0.58). After adjusting for the received fluid therapy, children in the metamizole group had significantly more emetic episodes and needed significantly more doses of ondansetron. No differences were observed between groups in relation to the need of opioids, problems associated with venous catheterization or mean days of admission. CONCLUSIONS In our cohort, ibuprofen had a similar analgesic efficacy and a better emetogenic profile than metamizole in the immediate postoperative period of PAA. Future prospective, adequately controlled studies with larger sample sizes are needed to validate these findings.