THE COMPARISON OF STEROID, NSAID, AND COMBINATION OF STEROID NSAID ON ANALGESIA AND INFLAMMATION IN PATIENT AFTER CHOLECYSTECTOMY SURGERY: RANDOMIZED CONTROLLED TRIAL

Abstract

Postoperative pain and inflammation remain major concerns following cholecystectomy. Although paracetamol, non-steroidal anti-inflammatory drugs, and corticosteroids are widely used, the most effective regimen for superior analgesia and anti-inflammatory control is still under debate. This study aimed to assess the effect of combining paracetamol, ibuprofen, and dexamethasone compared with single or dual regimens on postoperative pain and inflammatory markers. A randomized, double-blind, controlled trial was performed at RSUD Prof. Dr. Margono Soekarjo. Forty-five patients undergoing elective open cholecystectomy were randomized into three groups: Group A (paracetamol + dexamethasone), Group B (paracetamol + ibuprofen), and Group C (paracetamol + ibuprofen + dexamethasone). Serum interleukin-6 (IL-6) and prostaglandin E2 (PGE2) were measured pre- and post-intervention, and postoperative pain was evaluated with the Numeric Rating Scale (NRS). Statistical analysis was performed using IBM SPSS version 29.0, with significance set at p < 0.05. Baseline demographics were similar across groups (p > 0.05). Group C demonstrated the greatest IL-6 reduction (p = 0.047), while Group B showed an increase (p = 0.027) and Group A no significant change (p = 0.053). PGE2 levels were lowest in Group C, though intra-group differences were not significant. Postoperative NRS scores varied significantly (p < 0.001), with Group C reporting the lowest median score compared with Groups A and B. The combination of paracetamol, ibuprofen, and dexamethasone offers superior analgesia and greater reduction in IL-6 levels compared with single or dual regimens, supporting its role as an effective multimodal analgesic strategy after cholecystectomy.