Ibuprofen does not impair renal function in patients undergoing infrarenal aortic surgery with epidural anaesthesia

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Abstract

Objective:

To investigate the effect of preoperative ibuprofen administration on renal function during and after infrarenal aortic surgery under thoracolumbar epidural anaesthesia (EPA).

Design:

A prospective randomised, double-blinded clinical study.

Setting:

Operation room and intensive care unit in a university hospital.

Patients:

Twenty-six consecutive patients scheduled for elective infrarenal aortic surgery.

Interventions:

The patients were prospectively randomised to receive 400 mg ibuprofen intravenously (i. v.) or a placebo aliquot before surgery.

Measurements and results:

We assessed renal function by calculating creatinine clearance, and fractional sodium excretion before surgery (baseline), 1 h after cross-clamping (intraoperative), 6 h after cross-clamping (postoperative) and 24 h after cross-clamping (on the 1 st postoperative day). At each point in time, we additionally registered haemodynamics and determined the plasma concentration of 6-keto-PGF1α (stable metabolite of prostacyclin, PGI2), bicyclic PGE2 (stable metabolite of PGE1 E2), active renin, aldosterone and vasopressin by radioimmunoassays.

Measurements and results:

Throughout the observation period the renal function parameters mostly remained within the normal range without a significant difference between ibuprofen- and placebo-treated patients (creatinine clearance: baseline 41 ± 3 vs 38 ± 6, intraoperative 57 ± 8 vs 64 ± 11, postoperative 64 ± 9 vs 56 ± 9, first postoperative day 43 ± 5 vs 47 ± 6 ml · min · m-2, means ± SEM). The plasma levels of 6-keto-PGF1α (68 ± 8 vs 380 ± 71* ng · 1-1), bicyclic PGE2 (57 ± 5 vs 88 ± 9* ng · 1-1) and vasopressin (14 ± 7 vs 45 ± 10* ng · 1-1, p < 0.0125), however, were significantly higher during the intra-operative period in the placebo-treated patients.

Conclusion:

The inhibition of endogenous prostaglandin release by ibuprofen does not substantially impair renal function during infrarenal aortic surgery under EPA.

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