hip replacement

Acetaminophen Plus Ibuprofen Lessens Morphine Use Following Hip Replacement

Use of acetaminophen plus ibuprofen can significantly reduce morphine consumption in patients undergoing total hip arthroplasty (THA) compared with acetaminophen alone, according to the results of a recent study.


Although multimodal postoperative analgesia is widely used, evidence of benefit is lacking, according to the authors of the study.


They conducted a randomized, blinded, placebo-controlled, 4-group trial in 6 hospitals in Denmark, including data from 556 patients undergoing THA. The participants were randomly assigned to receive acetaminophen 1000 mg plus ibuprofen 400 mg (n = 136), acetaminophen1000 mg plus matched placebo (n = 142), ibuprofen 400 mg plus matched placebo (n = 141), or half-strength acetaminophen 500 mg plus ibuprofen 200 mg (n = 140) orally every 6 hours beginning 1 hour before surgery and for 24 hours postoperatively.


Overall, 556 of the 559 participants completed the trial. Median morphine consumption was significantly lower in patients given acetaminophen plus ibuprofen when compared with acetaminophen monotherapy (20 mg vs 36 mg). The difference between acetaminophen plus ibuprofen and ibuprofen monotherapy was not clinically significant (20 mg vs 26 mg).


“Among patients undergoing THA, [acetaminophen] plus ibuprofen significantly reduced morphine consumption compared with [acetaminophen]alone in the first 24 hours after surgery; there was no statistically significant increase in serious adverse events in the pooled groups receiving ibuprofen alone vs with [acetaminophen]alone. However, the combination did not result in a clinically important improvement over ibuprofen alone, suggesting that ibuprofen alone may be a reasonable option for early postoperative oral analgesia.”


—Michael Potts



Thybo KH, Hagi-Pedersen D, Dahl JB, et al. Effect of combination of paracetamol (acetaminophen) and ibuprofen vs either alone on patient-controlled morphine consumption in the first 24 hours after total hip arthroplasty. JAMA. 2019;321(6):562-571.