# Early Postoperative Analgesic Outcomes Following Pre-Induction Intravenous Ibuprofen in Children Undergoing Hypospadias Repair: A Randomized Controlled Study

## TL;DR

Giving ibuprofen before surgery helps reduce the need for painkillers in children after hypospadias repair without causing more side effects.

## Contribution

This study is the first to show the benefits of pre-induction ibuprofen for postoperative pain management in pediatric urological surgery.

## Key findings

- Pre-induction ibuprofen reduced the need for rescue opioid analgesia in the PACU.
- Ibuprofen lowered the incidence of moderate-to-severe pain without increasing adverse events.
- No significant differences were found in intraoperative opioid use or emergence delirium.

## Abstract

What are the main findings?
Pre-induction intravenous ibuprofen was associated with a lower proportion of children requiring rescue opioid analgesia in the postanesthesia care unit after hypospadias repair.Intravenous ibuprofen was associated with a lower incidence of moderate-to-severe pain in the immediate postoperative period without an increase in adverse events.

Pre-induction intravenous ibuprofen was associated with a lower proportion of children requiring rescue opioid analgesia in the postanesthesia care unit after hypospadias repair.

Intravenous ibuprofen was associated with a lower incidence of moderate-to-severe pain in the immediate postoperative period without an increase in adverse events.

What are the implications of the main findings?
Intravenous ibuprofen administered during anesthesia induction may be considered as a potential addition to postoperative pain management strategies for short-duration pediatric urological surgery.Integrating pain and emergency delirium scales may improve the interpretation of early postoperative pain outcomes in young children.

Intravenous ibuprofen administered during anesthesia induction may be considered as a potential addition to postoperative pain management strategies for short-duration pediatric urological surgery.

Integrating pain and emergency delirium scales may improve the interpretation of early postoperative pain outcomes in young children.

Background: Hypospadias repair is a pediatric surgical procedure associated with relatively pronounced postoperative pain. However, evidence guiding procedure-specific perioperative analgesic strategies remains limited. Although preoperative intravenous ibuprofen has demonstrated analgesic benefits in other pediatric surgical settings, data specific to pediatric urological surgery are scarce. Methods: In this randomized, double-blind, placebo-controlled trial, 104 children (2–7 years old, American Society of Anesthesiologists [ASA] physical status I–II) scheduled for urethroplasty were randomized to receive either intravenous ibuprofen (10 mg/kg; Group I) or saline (Group C) before anesthesia induction. The primary outcome was the proportion of patients requiring rescue opioid analgesia in the postanesthesia care unit (PACU). Secondary outcomes included postoperative FLACC (Face, Legs, Activity, Cry, Consolability), NRS-11 (the numerical rating scale-11 scale), and PAED (Pediatric Anesthesia Emergence Delirium) scores, repeated rescue analgesia, intraoperative opioid use, the LMA (laryngeal mask airway) removal time, and adverse events. Results: Ninety-three patients completed the study (Group I, n = 47; Group C, n = 46). The proportion of patients requiring rescue analgesia in the PACU was significantly lower in the ibuprofen group than in the control group (12.77% vs. 30.43%, p = 0.038, 95% CI: 0.116, 0.968). Moderate-to-severe pain (FLACC ≥ 4) in the PACU occurred less frequently in the ibuprofen group, whereas incidence of emergence delirium was similar between groups. No significant differences were observed in the pain scores on postoperative days 1 and 2, intraoperative opioid use, the LMA removal time, or adverse events. Conclusions: Pre-induction intravenous ibuprofen reduced early postoperative rescue analgesia requirements without increasing adverse events in children undergoing hypospadias repair.