Anest. intenziv. Med. 2025;36(4):247-252 | DOI: 10.36290/aim.2025.043

Comparison of ibuprofen and paracetamol combination with ketorolac and paracetamol in patients undergoing gynecologic surgery:  A review of pain level, coagulation profile, and interleukin-6 levelsOriginal Article

Maarif M. K.1, Musba A. M. T.1, 2, Datu M. D.1, 3, Gaus S.1, 2, Wirawan N. S.1, 3, Adil A.1, 2
1 Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
2 Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
3 Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Hasanuddin University Hospital, Makassar, Indonesia

Background: Postoperative pain management in gynecological surgery remains a significant challenge, with many patients experiencing moderate to severe pain despite standard analgesic interventions. The risk of complications, such as bleeding and prolonged recovery, is heightened by the use of certain analgesics, emphasizing the need for optimal pain management strategies. This study compares the efficacy of two multimodal analgesic regimens-ibuprofen-paracetamol and ketorolac-paracetamol-on pain, coagulation, and interleukin-6 (IL-6) levels. 



Methods: A double-blind randomized trial was conducted with 40 patients undergoing gynecological surgery. Group 1 received IV ibuprofen (400 mg) + paracetamol (1000 mg); Group 2 received IV ketorolac (30 mg) + paracetamol (1000 mg). Numeric Rating Scale (NRS), clotting time (CT), bleeding time (BT), and IL-6 were assessed at 6, 24, and 48 hours postoperatively. 



Results: Pain scores and CT did not differ significantly between the groups. The ketorolac group showed a significant increase in BT at 24 and 48 hours (p < 0.05), while the ibuprofen group had significantly lower IL-6 levels at 24 hours (p < 0.05). 



Conclusion: Both regimens were equally effective for pain control. However, ketorolac-paracetamol significantly prolonged bleeding time, while ibuprofen-paracetamol was more effective in reducing inflammation by lowering IL-6 levels. These differences should be considered, particularly in patients at risk of bleeding.

Keywords: pain management, coagulation profile, interleukin-6, ibuprofen, ketorolac, paracetamol, gynecological surgery

Received: July 6, 2025; Revised: September 22, 2025; Accepted: September 24, 2025; Prepublished online: November 21, 2025; Published: December 10, 2025  Show citation

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Maarif MK, Musba AMT, Datu MD, Gaus S, Wirawan NS, Adil A. Comparison of ibuprofen and paracetamol combination with ketorolac and paracetamol in patients undergoing gynecologic surgery:  A review of pain level, coagulation profile, and interleukin-6 levels. Anest. intenziv. Med. 2025;36(4):247-252. doi: 10.36290/aim.2025.043.
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