Ibuprofen does not impair renal function in patients undergoing infrarenal aortic surgery with epidural anaesthesia.
OBJECTIVE
To investigate the effect of preoperative ibuprofen administration on renal function during and after infrarenal aortic surgery under thoracolumbar epidural anaesthesia (EPA).


METHODS
A prospective randomised, double-blinded clinical study.


METHODS
Operation room and intensive care unit in a university hospital.


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


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


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-PGF1alpha (stable metabolite of prostacyclin, PGI2), bicyclic PGE2 (stable metabolite of PGE1 E2), active renin, aldosterone and vasopressin by radioimmunoassays. 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 x min x m(-2), means +/- SEM). The plasma levels of 6-keto-PGF1alpha (68 +/- 8 vs 380 +/- 71* ng x l(-1)), bicyclic PGE2 (57 +/- 5 vs 88 +/- 9* ng x l(-1)) and vasopressin (14 +/- 7 vs 45 +/- 10* ng x l(-1), p < 0.0125), however, were significantly higher during the intraoperative period in the placebo-treated patients.


CONCLUSIONS
The inhibition of endogenous prostaglandin release by ibuprofen does not substantially impair renal function during infrarenal aortic surgery under EPA.
Brinkmann
A
A
University Clinics Ulm, Department of Anaesthesiology, Germany.
Seeling
W
W
Wolf
C F
CF
Kneitinger
E
E
Vogt
N
N
Steinbach
G
G
Orend
K H
KH
Radermacher
P
P
Georgieff
M
M
D000368:Aged; D000767:Anesthesia, Epidural; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000378:metabolism / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D015232:Dinoprostone / Q000097:blood; D004311:Double-Blind Method; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies; D011460:Prostaglandins F / Q000097:blood
D016861:Cyclooxygenase Inhibitors; D011460:Prostaglandins F; D003404:Creatinine; D015232:Dinoprostone; C100006:prostaglandin F1; D007052:Ibuprofen