Analgesic Efficacy of Acetaminophen/Ibuprofen as an Adjuvant in Patient-Controlled Analgesia for Postoperative Pain After Oncoplastic Breast Surgery: A Randomized Controlled Trial

Abstract

Background/Objectives: Although patients with breast cancer often undergo multiple oncologic procedures after primary tumor resection, an optimal postoperative analgesic strategy remains undefined. We evaluated the efficacy of acetaminophen/ibuprofen as an adjunct to opioid-based patient-controlled analgesia (PCA) following oncoplastic breast surgery. Methods: In this double-blind randomized controlled trial, 79 patients were assigned to receive either acetaminophen/ibuprofen or saline. A 100 mL solution containing 1000 mg acetaminophen and 300 mg ibuprofen was administered at the end of surgery, and 200 mL was incorporated into a fentanyl-based PCA for infusion over 48 h. The control group received an equivalent volume of saline. The primary outcome was pain intensity at 1 h postoperatively, assessed using an 11-point numerical rating scale. Secondary outcomes included pain scores at 6, 24, and 48 h, cumulative fentanyl consumption via PCA, additional analgesic use, and adverse effects. Results: Pain scores at 1 h postoperatively were significantly lower in the intervention group than in the control group (median [IQR], 2 [2, 2] vs. 2 [2, 3], p = 0.040). Cumulative fentanyl volume administered via PCA was lower in the intervention group at 24 h (252.4 [186.7, 289.9] mcg vs. 299.7 [208.3, 366.6] mcg, p < 0.001) and 48 h (482.4 [283.2, 548.0] mcg vs. 537.0 [390.9, 586.0] mcg, p = 0.001). Fewer patients in the intervention group required rescue analgesics during the first 6 h (22 [56.4%] vs. 32 [80.0%], p = 0.024). Pain scores and rescue analgesic use thereafter did not differ between groups. Conclusions: Adjunctive acetaminophen/ibuprofen with opioid-based PCA reduced early postoperative pain, opioid consumption, and rescue analgesia without increasing adverse effects.