Ibuprofen Just As Effective As Tylenol, Morphine After Hip Surgery, Without Side Effect Risks

Following hip surgery, the use of Advil appears to be more effective than taking Tylenol at reducing the amount of morphine needed, according to the findings of a new study. 

Researchers from Denmark indicate Advil (Ibuprofen) helps patients potentially avoid an opioid addiction and carries fewer side effects than both Tylenol and morphine. The findings were published in the Journal of the American Medical Association (JAMA) on February 12.

The study focused on the effect of Advil and Tylenol, also known under generic names acetaminophen or paracetamol, testing use of the drugs alone and in combination postoperatively to help reduce morphine use after total hip arthroplasty (THA).

During the randomized control clinical trial, researchers studied pain medication effects for 556 patients who underwent total hip arthroplasty in Danish hospitals. The patients underwent surgery from December 2015 to October 2017, with a 90-day followup period.

Participants were randomized into one of four groups. They received either 1,000 mg of Tylenol plus 400 mg of Advil; 1,000 mg of Tylenol plus a placebo; 400 mg of Advil plus a placebo; or half strength Tylenol at 500 mg plus 200 mg of Advil. The medications were given orally every six hours for 24 hours after surgery.

The group given Tylenol plus Advil had an average morphine consumption during the first 24 hours of 20 mg. The group given only Tylenol had an average morphine consumption of 36 mg while the group give Advil alone had an average morphine consumption of 26 mg. Finally, the group given half strength Tylenol and Advil had an average consumption of 28 mg.

Morphine usage in the first 24 hours was significantly lower for the combination of 1,000 mg of Tylenol and 400 mg of Advil than for either drug alone.

Patients who took the combined medications had the largest reduction in morphine consumption. However, researchers said it did not meet the threshold as clinically important. This is because morphine consumption with the two combined medications was not reduced significantly enough compared to using Advil alone.

Furthermore, serious adverse effects occurred 15 percent of the time in Tylenol patients and 11 percent of the time in Advil patients.

Prior studies have indicated taking Tylenol for any type of pain relief carries serious side effects. Nearly half of all drug-induced liver injuries in the U.S. are caused by taking Tylenol.

Reducing patient morphine consumption is especially important as the U.S. faces an ever worsening opioid crisis, often stemming from doctor overprescribing. Morphine is a strong opioid given to manage surgical pain, but is highly addictive.

Opioids account for 70 percent of all overdose deaths in the United States. The risk of accidental opioid overdose is now higher than the risk of dying in a car crash.

“Although the combined use of paracetamol and ibuprofen reduced immediate postoperative morphine consumption compared with paracetamol alone in patients undergoing THA, ibuprofen alone resulted in comparable pain control without increasing (serious adverse effects), suggesting that ibuprofen alone may be a reasonable option,” the researchers concluded.