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Laparoskopik Kolesistektomide İntravenöz İbuprofen ve Asetaminofenin Postoperatif Ağrı ve Tramadol Tüketimi Üzerine Etkinliği: Prospektif, Randomize, Çift Kör Klinik Çalışma

Year 2023, , 172 - 178, 23.03.2023
https://doi.org/10.18663/tjcl.1260384

Abstract

Amaç: Laparoskopik kolesistektomi (LC) sonrası postoperatif ağrıyı yönetmek için multimodal analjezi de dahil olmak üzere birçok teknik kullanılmıştır. İntravenöz ibuprofen (IV) kullanan çalışmaların sayısı hala sınırlı olsa da, ibuprofenin postoperatif ağrı yönetiminde potansiyel bir rolü olduğu gösterilmiştir. Bu çalışmanın birincil amacı, LC uygulanan hastalarda IV ibuprofen ve asetaminofen formlarının postoperatif 24 saatlik opioid tüketimi ve ağrı yönetimi üzerindeki etkisini değerlendirmek ve karşılaştırmaktır. Çalışmanın ikincil amacı, ibuprofen ve asetaminofenin opioidle ilişkili advers olaylar (ORAE) üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: Bu çalışma prospektif, randomize, çift kör bir klinik çalışmaydı. Etik kurul onayı alındıktan sonra yaşları 18 ile 65 arasında değişen, American Society of Anesthesiology (ASA) skoru I-II olan ve LC planlanan 70 hasta çalışmaya alındı. Hastalar rastgele iki gruba ayrıldı. Ameliyat sırasında kontrol grubu (n=35) 100 mL salin içinde 800 mg IV ibuprofen (grup I), asetaminofen grubu (n=35) 1000 mg (grup A) aldı. Postoperatif dönemde tüm hastalara tramadollu hasta kontrollü analjezi (HKA) cihazı verildi. PCA cihazı, 10 mg bolus dozuna ayarlandı ve 15 dakikalık bir kilitleme süresine sahipti. Kör bir ağrı hemşiresi, postoperatif analjeziyi sayısal derecelendirme ölçeği (NRS) kullanarak 1, 2, 4, 6, 12 ve 24. saatlerde değerlendirdi. Postoperatif 24 saatlik dönemde postoperatif bulantı ve kusma insidansı, toplam tramadol tüketimi ve ek analjezik ihtiyacı kaydedildi.
Bulgular: Bu çalışmaya LC uygulanan 70 hasta katıldı. Analjezik ilaç kullanımı grup I'de diğer grup A'ya göre istatistiksel olarak daha düşüktü. İV ibuprofen ve asetaminofen grupları arasında NRS skorları postoperatif 1, 2, 4, 6, 12 ve 24. saatlerde istatistiksel olarak benzerdi (P>0.05) . 24 saatlik opioid tüketimi grup A'da grup I'e göre istatistiksel olarak anlamlı derecede yüksekti (P<0.05). Ayrıca analjezik kullanımı grup I ve grup A'da istatistiksel olarak benzerdi (P>0,05). POBK oranları ibuprofen ve asetaminofen gruplarında benzerdi (P>0.05). ORAE'ler gruplar arasında benzerdi.
Sonuç: Tramadol bazlı multimodal analjezinin bir parçası olarak ibuprofen, elektif LC cerrahisini takiben postoperatif ilk 24 saat boyunca asetaminofene kıyasla tramadol tüketimini azaltmıştır. IV ibuprofen-tramadol kombinasyonu, bir asetaminofen-tramadol kombinasyonundan üstün göründü. ORAE'ler her iki grupta da benzerdi.

Supporting Institution

YOKTUR

References

  • 1. Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg. 1992;127:917–21. discussion 921–3
  • 2. JohanssonM, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg. 2005;92:44–9
  • 3. Protic M, Veljkovic R, Bilchik AJ, et al. Prospective randomized controlled trial comparing standard analgesia with combined intra operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy. Surg Endosc. 2017;31:704–13
  • 4. Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77: 1048-56
  • 5. American Society of Anesthesiologists Task Force on Acute Pain ManagementPractice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116:248–73
  • 6. Beilin B, Shavit Y, Trabekin E, et al. Anesth Analg. 2003;97(3):822-7
  • 7. Gottschalk A, Smith DS. New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician. 2001;63(10):1979-84
  • 8. Dirks J, Møiniche S, Hilsted KL, Dahl JB. Mechanisms of postoperative pain: clinical indications for a contribution of central neuronal sensitization. Anesthesiology. 2002;97(6):1591-6
  • 9. Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New advances in acute postoperative pain management. Curr Pain Headache Rep. 2018;22:35
  • 10. Puntillo F, Giglio M, Varrassi G. The routes of administration for acute postoperative pain medication. Pain Ther. 2021;10:909–25
  • 11. Aweke Z, Seyoum F, Shitemaw T, Doba DN. Comparison of preemptive acetaminophen, acetaminophen-diclofenac & acetaminophen-tramadol combination on postoperative pain after elective abdominal surgery under general anesthesia, Ethiopia: a randomized control trial study, 2018. BMC Anesthesiol. 2020;4:191
  • 12. Shah DD, Sorathia ZH. Tramadol/Diclofenac fixed-dose combination: a review of its use in severe acute pain. Pain Ther. 2020;9:113–28
  • 13. Choi SW, Cho HK, Park S. Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery. J Clin Med. 2020;11:1087
  • 14. Svensson CI, Yaksh TL. The spinal phospholipasecyclooxygenase-prostanoid cascade in nociceptive processing. Annu Rev Pharmacol Toxicol. 2002;42:553-83
  • 15. Gago Martinez A, Escontrela Rodriguez B, Planas Roca A, et al. Intravenous ibuprofen for treatment of post-operative pain: a multicenter, double blind, placebo-controlled, randomized clinical trial. PLoS One. 2016;11:e0154004
  • 16. Moss JR, Watcha MF, Bendel LP, McCarthy DL, Witham SL, Glover CD. A multicenter, randomized, double-blind placebo-controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy. Pediatric Anesth. 2014;24 (5):483-9
  • 17. Southworth SR, Woodward EJ, Peng A, Rock AD (2015) An integrated safety analysis of intravenous ibuprofen (Caldolor((R))) in adults. J Pain Res. 2015;8:753–65
  • 18. Liu C, Ulualp SO (2015) Outcomes of an alternating ibuprofen and acetaminophen regimen for pain relief after tonsillectomy in children. Ann Otol Rhinol Laryngol. 124(10):777–81
  • 19. Koh W, Nguyen KP, Jahr JS. Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesthesiol. 2015. 68(1):3-12
  • 20. Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth. 2016; 117(Suppl 3): iii62-iii72
  • 21. Martinez V, Beloeil H, Marret E, Fletcher D, Ravaud P, Trinquart L. Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials. Br J Anaesth. 2017; 118: 22-31
  • 22. Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth. 2001;48:1000–10
  • 23. Kroll PB, Meadows L, Rock A, Pavliv L. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen (i.v.-ibuprofen) in the management of postoperative pain following abdominal hysterectomy. Pain Pract. 2011;11(1):23-32
  • 24. Gan TJ, Candiotti K, Turan A, et al. The shortened infusion time of intravenous ibuprofen, part 2: a multicenter, open-label, surgical surveillance trial to evaluate safety. Clin Ther. 2015;37(2):368–75
  • 25. Cattabriga I, Pacini D, Lamazza G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. Cardiothorac Surg. 2007 Sep;32(3):527-31
  • 26. Crews JC. Multimodal pain management strategies for office-based and ambulatory procedures. JAMA 2002; 288: 629-32
  • 27. Ucar MA, Erdogan MA, Sanlı M, Colak YZ, Aydoğan MS, Aytaç yücel. Efficacy of Intravenous Ibuprofen and Intravenous Acetaminophen in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy. Journal of PeriAnesthesia Nursing. 2022;37:540-4
  • 28. Ahiskalioglu EO, Ahiskalioglu A, Aydin P, Yayık AM, Temiz A. Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine. 2017;96(8):e6200
  • 29. Kayhan GK, Sanli M, Ozgul U, Kirteke R, Yologlu S. Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial. J of Clinical Anesthesia. 2018;50:5-11
  • 30. Sparber LS, Lau CS, Vialet TS, Chamberlain RS. Preoperative intravenous ibuprofen does not influence postoperative narcotic use in patients undergoing elective hernia repair: a randomized, double-blind, placebo controlled prospective trial. J Pain Res. 2017;10:1555–60
  • 31. Erdi AM, Arabzadeh AA, IssazadehFar K, Masoumzadeh M, Bahadoram M. Comparing the Efficacy and Side Effects of Intravenous Ibuprofen and Acetaminophen in Pain Control Following Laparoscopic Cholecystectomy. World J Plast Surg. 2022;11(1):117-24
  • 32. Akbas S, Ozkan AS, Durak MA, Yologlu S. Efficacy of Intravenous Acetaminophen and Ibuprofen on Postoperative Pain and Morphine Consumption in Lumbar Disc Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Neurochirurgie. 2021;67:533-9
  • 33. Ekinci Mursel, Ciftci B, Celik EC, Köse EA, Karakaya MA, Ozdenkaya Y. A Randomized, Placebo-Controlled, Double-Blind Study that Evaluates Efficacy of Intravenous Ibuprofen and Acetaminophen for Postoperative Pain Treatment Following Laparoscopic Cholecystectomy Surgery. J Gastrointest Surg. 2020;24:780-5

Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial

Year 2023, , 172 - 178, 23.03.2023
https://doi.org/10.18663/tjcl.1260384

Abstract

Background: Many techniques, including multimodal analgesia, have been used to manage postoperative pain after laparoscopic cholecystectomy (LC). Although the number of studies using intravenous ibuprofen (IV) is still limited, ibuprofen has been shown to have a potential role in managing postoperative pain. The primary outcome of this study is to evaluate and compare the impact of IV forms of ibuprofen and acetaminophen on 24-hour postoperative opioid consumption and pain management in patients undergoing LC. The second outcome of the study is to evaluate the impact of ibuprofen and acetaminophen on opioid-related adverse events (ORAE).
Materials and Methods: This study was a prospective, randomized, double-blind clinical trial. Following ethical committee approval, 70 patients aged 18 to 65, American Society of Anesthesiology (ASA) score I- II, and those scheduled for LC were enrolled in the study. Patients were randomly divided into two groups. The control group (n=35) received 800 mg IV ibuprofen (group I) in 100 mL saline during surgery, while the acetaminophen group (n=35) received 1000 mg (group A). In the postoperative period, all patients received a patient-controlled analgesia (PCA) device with tramadol. The PCA device was set to a bolus dose of 10 mg and had a lockout time of 15 minutes. A blinded pain nurse assessed postoperative analgesia at 1, 2, 4, 6, 12, and 24 hours using a numerical rating scale (NRS). The incidence of postoperative nausea and vomiting (PONV), total tramadol consumption, and the need for additional analgesics during the 24-hour postoperative period were recorded.
Results: Seventy patients who underwent LC participated in this study. The use of analgesic medications was statistically lower in group I than in the other group A. NRS scores between the IV ibuprofen and acetaminophen groups were statistically similar at 1, 2, 4, 6, 12, and 24 hours postoperatively (P>0.05). 24-hour opioid consumption was statistically significantly higher in group A than in group I (P<0.05). In addition, analgesic use was statistically similar in group I and group A (P>0.05). PONV rates were similar in the ibuprofen and acetaminophen groups (P>0.05). ORAEs were similar between groups.
Conclusion: Ibuprofen as part of tramadol-based multimodal analgesia reduced tramadol consumption compared to acetaminophen during the first 24 hours postoperatively following elective LC surgery. The IV ibuprofen-tramadol combination appeared superior to an acetaminophen-tramadol combination. ORAEs were similar in both groups.

References

  • 1. Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg. 1992;127:917–21. discussion 921–3
  • 2. JohanssonM, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg. 2005;92:44–9
  • 3. Protic M, Veljkovic R, Bilchik AJ, et al. Prospective randomized controlled trial comparing standard analgesia with combined intra operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy. Surg Endosc. 2017;31:704–13
  • 4. Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77: 1048-56
  • 5. American Society of Anesthesiologists Task Force on Acute Pain ManagementPractice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116:248–73
  • 6. Beilin B, Shavit Y, Trabekin E, et al. Anesth Analg. 2003;97(3):822-7
  • 7. Gottschalk A, Smith DS. New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician. 2001;63(10):1979-84
  • 8. Dirks J, Møiniche S, Hilsted KL, Dahl JB. Mechanisms of postoperative pain: clinical indications for a contribution of central neuronal sensitization. Anesthesiology. 2002;97(6):1591-6
  • 9. Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New advances in acute postoperative pain management. Curr Pain Headache Rep. 2018;22:35
  • 10. Puntillo F, Giglio M, Varrassi G. The routes of administration for acute postoperative pain medication. Pain Ther. 2021;10:909–25
  • 11. Aweke Z, Seyoum F, Shitemaw T, Doba DN. Comparison of preemptive acetaminophen, acetaminophen-diclofenac & acetaminophen-tramadol combination on postoperative pain after elective abdominal surgery under general anesthesia, Ethiopia: a randomized control trial study, 2018. BMC Anesthesiol. 2020;4:191
  • 12. Shah DD, Sorathia ZH. Tramadol/Diclofenac fixed-dose combination: a review of its use in severe acute pain. Pain Ther. 2020;9:113–28
  • 13. Choi SW, Cho HK, Park S. Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery. J Clin Med. 2020;11:1087
  • 14. Svensson CI, Yaksh TL. The spinal phospholipasecyclooxygenase-prostanoid cascade in nociceptive processing. Annu Rev Pharmacol Toxicol. 2002;42:553-83
  • 15. Gago Martinez A, Escontrela Rodriguez B, Planas Roca A, et al. Intravenous ibuprofen for treatment of post-operative pain: a multicenter, double blind, placebo-controlled, randomized clinical trial. PLoS One. 2016;11:e0154004
  • 16. Moss JR, Watcha MF, Bendel LP, McCarthy DL, Witham SL, Glover CD. A multicenter, randomized, double-blind placebo-controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy. Pediatric Anesth. 2014;24 (5):483-9
  • 17. Southworth SR, Woodward EJ, Peng A, Rock AD (2015) An integrated safety analysis of intravenous ibuprofen (Caldolor((R))) in adults. J Pain Res. 2015;8:753–65
  • 18. Liu C, Ulualp SO (2015) Outcomes of an alternating ibuprofen and acetaminophen regimen for pain relief after tonsillectomy in children. Ann Otol Rhinol Laryngol. 124(10):777–81
  • 19. Koh W, Nguyen KP, Jahr JS. Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesthesiol. 2015. 68(1):3-12
  • 20. Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth. 2016; 117(Suppl 3): iii62-iii72
  • 21. Martinez V, Beloeil H, Marret E, Fletcher D, Ravaud P, Trinquart L. Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials. Br J Anaesth. 2017; 118: 22-31
  • 22. Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth. 2001;48:1000–10
  • 23. Kroll PB, Meadows L, Rock A, Pavliv L. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen (i.v.-ibuprofen) in the management of postoperative pain following abdominal hysterectomy. Pain Pract. 2011;11(1):23-32
  • 24. Gan TJ, Candiotti K, Turan A, et al. The shortened infusion time of intravenous ibuprofen, part 2: a multicenter, open-label, surgical surveillance trial to evaluate safety. Clin Ther. 2015;37(2):368–75
  • 25. Cattabriga I, Pacini D, Lamazza G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. Cardiothorac Surg. 2007 Sep;32(3):527-31
  • 26. Crews JC. Multimodal pain management strategies for office-based and ambulatory procedures. JAMA 2002; 288: 629-32
  • 27. Ucar MA, Erdogan MA, Sanlı M, Colak YZ, Aydoğan MS, Aytaç yücel. Efficacy of Intravenous Ibuprofen and Intravenous Acetaminophen in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy. Journal of PeriAnesthesia Nursing. 2022;37:540-4
  • 28. Ahiskalioglu EO, Ahiskalioglu A, Aydin P, Yayık AM, Temiz A. Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine. 2017;96(8):e6200
  • 29. Kayhan GK, Sanli M, Ozgul U, Kirteke R, Yologlu S. Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial. J of Clinical Anesthesia. 2018;50:5-11
  • 30. Sparber LS, Lau CS, Vialet TS, Chamberlain RS. Preoperative intravenous ibuprofen does not influence postoperative narcotic use in patients undergoing elective hernia repair: a randomized, double-blind, placebo controlled prospective trial. J Pain Res. 2017;10:1555–60
  • 31. Erdi AM, Arabzadeh AA, IssazadehFar K, Masoumzadeh M, Bahadoram M. Comparing the Efficacy and Side Effects of Intravenous Ibuprofen and Acetaminophen in Pain Control Following Laparoscopic Cholecystectomy. World J Plast Surg. 2022;11(1):117-24
  • 32. Akbas S, Ozkan AS, Durak MA, Yologlu S. Efficacy of Intravenous Acetaminophen and Ibuprofen on Postoperative Pain and Morphine Consumption in Lumbar Disc Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Neurochirurgie. 2021;67:533-9
  • 33. Ekinci Mursel, Ciftci B, Celik EC, Köse EA, Karakaya MA, Ozdenkaya Y. A Randomized, Placebo-Controlled, Double-Blind Study that Evaluates Efficacy of Intravenous Ibuprofen and Acetaminophen for Postoperative Pain Treatment Following Laparoscopic Cholecystectomy Surgery. J Gastrointest Surg. 2020;24:780-5
There are 33 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Zeynep Ersoy

Çoşkun Araz

Publication Date March 23, 2023
Published in Issue Year 2023

Cite

APA Ersoy, Z., & Araz, Ç. (2023). Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial. Turkish Journal of Clinics and Laboratory, 14(1), 172-178. https://doi.org/10.18663/tjcl.1260384
AMA Ersoy Z, Araz Ç. Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial. TJCL. March 2023;14(1):172-178. doi:10.18663/tjcl.1260384
Chicago Ersoy, Zeynep, and Çoşkun Araz. “Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-Blinded Clinical Trial”. Turkish Journal of Clinics and Laboratory 14, no. 1 (March 2023): 172-78. https://doi.org/10.18663/tjcl.1260384.
EndNote Ersoy Z, Araz Ç (March 1, 2023) Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial. Turkish Journal of Clinics and Laboratory 14 1 172–178.
IEEE Z. Ersoy and Ç. Araz, “Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial”, TJCL, vol. 14, no. 1, pp. 172–178, 2023, doi: 10.18663/tjcl.1260384.
ISNAD Ersoy, Zeynep - Araz, Çoşkun. “Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-Blinded Clinical Trial”. Turkish Journal of Clinics and Laboratory 14/1 (March 2023), 172-178. https://doi.org/10.18663/tjcl.1260384.
JAMA Ersoy Z, Araz Ç. Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial. TJCL. 2023;14:172–178.
MLA Ersoy, Zeynep and Çoşkun Araz. “Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-Blinded Clinical Trial”. Turkish Journal of Clinics and Laboratory, vol. 14, no. 1, 2023, pp. 172-8, doi:10.18663/tjcl.1260384.
Vancouver Ersoy Z, Araz Ç. Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial. TJCL. 2023;14(1):172-8.


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