IV Ibuprofen
Caldolor
IV non-steroidal anti-inflammatory (non-selective COX inhibitor)
Reversibly inhibits COX-1/COX-2 → ↓ prostaglandins → analgesia, antipyresis, anti-inflammation. Opioid-sparing multimodal component.
Indications
- •Postoperative pain (multimodal)
- •Fever
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Pain | 400–800 mg IV q6h (infuse over ≥10 min); max 3200 mg/day | — |
Pharmacokinetics
Onset minutes IV. Half-life ~2 h. Hepatic.
Side effects
- !Platelet dysfunction / bleeding
- !Renal injury (esp. hypovolemia)
- !GI ulceration
- !Fluid retention/HTN
- !Bronchospasm (AERD)
Contraindications
- ×CABG perioperative period (Black Box — NSAID class)
- ×Renal impairment/hypovolemia
- ×Active GI bleed
- ×3rd-trimester pregnancy
- ×Aspirin-exacerbated respiratory disease
Clinical pearls
- ★Opioid-sparing multimodal analgesic — but weigh renal/bleeding/anastomotic concerns per surgery.
- ★NSAID class contraindication around CABG.
Other drugs in Narcotics & Analgesics
- Fentanyl
μ-opioid receptor agonist. ~100× potency of morphine.
- Remifentanil
μ-opioid agonist. Ester linkage hydrolyzed by nonspecific tissue + plasma esterases — no organ-dependent clearance.
- Morphine
μ-opioid receptor agonist. Active metabolite morphine-6-glucuronide (M6G) is analgesic and renally cleared — accumulates in renal failure → prolonged sedation/respiratory depression. Causes histamine release.
- Hydromorphone
μ-opioid agonist ~5–7× more potent than morphine. No clinically significant active metabolites → safer than morphine in renal failure. Less histamine release.
- Sufentanil
Most potent opioid in common clinical use — ~1000× morphine, ~10× fentanyl. High lipid solubility.
- Alfentanil
μ-opioid agonist ~1/5–1/10 the potency of fentanyl but FASTEST onset of the family — low pKa means a high non-ionized fraction at physiologic pH.
- Meperidine
μ-opioid agonist ~1/10 morphine, plus κ-agonism (anti-shivering). Active metabolite normeperidine is renally cleared, proconvulsant, and neurotoxic.
Suggested reading
- •Stoelting & Hines, Pharmacology & Physiology in Anesthetic Practice, 6e
- •Miller's Anesthesia, 9e
- •FDA package insert
