Orthopedic Pain Study6

Study Description

A multi-center, randomized, double-blind, placebo-controlled trial evaluating the safety and analgesic efficacy of IV Ibuprofen vs. placebo in 185 patients undergoing elective orthopedic surgery.

Study Results

In a study by Singla et al. 185 patients were enrolled in a multi-center, double-blind, placebo-controlled trial. Each patient had elective orthopedic surgery consisting of knee or hip replacement, reconstruction, or arthroplasty. CALDOLOR or a placebo was administered at induction of anesthesia and every 6 hours for 5 doses, and then as needed every 6 hours during the post-operative hospital stay. All patients had open access to morphine. Pain assessments were initiated when patients were alert in the recovery room. The primary objective of the study was to determine the efficacy of CALDOLOR (IV Ibuprofen) compared with placebo for the treatment of post-operative surgical pain demonstrated by patient self-assessment of pain with movement, using a Visual Analog Scale (VAS). The secondary endpoints evaluated early post-operative pain relief and morphine usage. While patients were excluded if they were receiving full dose anticoagulation therapy, approximately 19% of the patients enrolled in the study were receiving partial anticoagulation therapy in the 12 hours preceding surgery and 60% received anticoagulation therapy following surgery.

Morphine Use:

  • There was a 31% reduction in morphine use in the immediate 28 hour period after surgery  (p< 0.001).

VAS assessed at rest and with movement with 800 mg IV Ibuprofen over the immediate 28 hours following surgery:*

  • Study demonstrated a 32% reduction in VAS scores at rest with IV Ibuprofen in the immediate 28 hour period following surgery  (p< 0.001).
  • Study demonstrated a 26% reduction in VAS scores with movement in the immediate 28 hour period following surgery with IV Ibuprofen  (p< 0.001).
  • Patients woke up in less pain immediately after surgery (mean 2.81 hours) compared to placebo:
    • 15.8% decrease in mean VAS at rest (p= 0.012)
    • 13.9% decrease in mean VAS with movement (p= 0.003)
  • Patients remained in less pain throughout the post-operative period.
  • The most common adverse events reported in this study were nausea, vomiting, constipation, pyrexia and pruritus.

VAS = visual analog pain scale
* Statistical significance was demonstrated at each assessment period.


CALDOLOR in vials must be diluted prior to use. Infusion of the drug product in the vial without dilution can cause hemolysis. CALDOLOR in the vial should not be given as an IV bolus or IM injection.1

CALDOLOR is also available in a ready-to-use bag that requires no dilution prior to use. 1

CALDOLOR is indicated in adults and pediatric patients 6 months and older for the:

  • Management of mild to moderate pain and the management of moderate to severe pain as an adjunct to opioid analgesics
  • Reduction of fever

CALDOLOR Injection 800 mg/8 mL (100 mg/mL) vials must be diluted prior to administration.

CALDOLOR Injection 800 mg/200 mL (4 mg/mL) bags are ready to use and require no dilution prior to use.

Do not exceed 3,200 mg total daily dose in adults. Do not exceed 40 mg/kg or 2,400 mg, whichever is less, total daily dose in pediatric patients less than 17 years of age.

CALDOLOR is contraindicated in patients with known hypersensitivity (e.g., anaphylactic reactions and serious skin reactions) to ibuprofen or any components of the drug product, and in patients who have a history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. CALDOLOR is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

CALDOLOR should be used with caution in patients with known cardiovascular (CV) disease or risk factors for CV disease, a history of peptic ulcer disease and/or GI bleeding, liver disease or symptoms of, hypertension, and heart failure. When used in such patients, attention to using the lowest effective dose for the shortest time period is important to reduce the risk of serious adverse events. Avoid use in pregnant women starting at 30 weeks gestation.

The most common adverse reactions are nausea, flatulence, vomiting, headache, hemorrhage and dizziness (>5%). The most common adverse reactions in pediatric patients are infusion site pain, vomiting, nausea, anemia and headache (≥2%).


Cardiovascular Thrombotic Events

  • Non-steroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
  • CALDOLOR is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
Gastrointestinal Bleeding, Ulceration and Perforation
  • NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.