Ibuprofen (Multimodal Post-Operative Analgesia)

How it works

It inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis and thereby attenuating inflammation, peripheral and central pain sensitisation following surgery.

Prescribing in practice

• Avoid or use with great caution where there is renal impairment, hypovolaemia or significant bleeding risk, as perioperative NSAIDs can precipitate acute kidney injury and increase surgical-site or gastrointestinal bleeding.
• Co-prescribe with paracetamol as the analgesic backbone and add gastroprotection in patients at gastrointestinal risk; take with or after food.
• Weigh cardiovascular risk and avoid in active peptic ulceration, severe heart failure, and where the surgeon has specified NSAID avoidance (e.g. certain anastomotic or bariatric procedures).

Monitoring

Monitor renal function and fluid balance, blood pressure, and for signs of gastrointestinal or surgical-site bleeding, particularly in older or higher-risk patients.

Counselling the patient

• Take with food and use alongside your other pain medicines for the short course advised after surgery.
• Report indigestion, black stools, reduced urine output or unusual bleeding.

Evidence & guidelines

NSAIDs as part of multimodal, opioid-sparing analgesia are supported by enhanced-recovery and UK perioperative guidance, balanced against renal, bleeding and cardiovascular cautions in the SPC.