Paracetamol and ibuprofen as effective as non-opioid alternatives for postpartum pain control: Study

Longterm use of opioid medications is associated with several disadvantages, including substance dependency and breastfeeding that can be affected by the transfer of opioids through breastfeeding, potentially leading to undesirable effects on the newborn, such as drowsiness. These concerns have led to the search for equally effective non-opioid strategies for postpartum pain relief to replace opioid use and enhance recovery. While numerous analgesic regimens are commonly practiced in the clinical setting, scientific literature on comparisons of their efficacy is lacking. Paracetamol and members of the NSAIDs family, such as ibuprofen, are among those agents used in common practice.

It has not been established which non-opioid interventions are effective for specific types or locations of pain (e.g., perineal pain, uterine contractions, back pain), nor have the factors of general reduction of postpartum pain, the time interval between childbirth and the need for pain relief, and the potential impact of pain control on breastfeeding ability. Thus, authors aimed to compare single administration of nonopioid medications, specifically paracetamol (1000 mg) and ibuprofen (400 mg) in terms of their effectiveness in relieving general postpartum pain across different time frames. Study also aimed to assess the association between postpartum pain relief with the time to the initiation of breastfeeding, mobility and spontaneous urination, and the need for additional pain relief.

This randomized controlled study at a university-afliated medical center involved parturient who received blindly oral tablets of either 1000 mg of paracetamol or 400 mg of ibuprofen, post-vaginal birth. Pain levels were assessed using a numeric rating scale (NRS) at four time points: before treatment, and 1, 4, and 6 h post-treatment (T0, T1, T4, and T6, respectively). Authors also compared the need for additional analgesia, breastfeeding initiation, mobilization, and urination following the delivery between the groups. To ensure statistical power, the study was designed to detect differences of one point on the NRS with at least 37 women per group.

A total of 107 women participated, including paracetamol (n=52) and ibuprofen (n=55) groups. Demographics and perinatal outcomes were similar across groups. No significant differences were found in the interval between delivery and request for pain control (8±6–10.5 and 11±6–16 h for the paracetamol and the ibuprofen, respectively, P=.13). Pain levels on the NRS were similar for both groups at all intervals. There were also no group diferences in the time to the initiation of breastfeeding, mobilization, urination, or the need for additional analgesia.

This study compared ibuprofen (400 mg) and paracetamol (1000 mg) for the management of postpartum pain. These findings indicated no significant differences in the effectiveness of both medications in time from delivery to the request for analgesia, pain reduction at various time points, the need for additional analgesia, initiation of breastfeeding, and maternal mobilization and urination times post-delivery.

In conclusion, the findings of this study suggest comparable effectiveness of paracetamol and ibuprofen for immediate postpartum analgesia and indicate that both medications can be considered as a non-opioid alternative for postpartum pain control. Further research is warranted to validate these conclusions.

Source: Shai Ram, Dotan Madar, Hila Shalev Ram; Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-024-07797-4