IBUPROFEN DOES NOT IMPAIR RENAL-FUNCTION IN PATIENTS UNDERGOING INFRARENAL AORTIC-SURGERY WITH EPIDURAL-ANESTHESIA

Objective: To investigate the effect of preoperative ibuprofen adminis tration on renal function during and after infrarenal aortic surgery u nder thoracolumbar epidural anaesthesia (EPA). Design: A prospective r andomised, double-blinded clinical study. Setting: Operation room and intensive care unit in a university hospital. Patients: Twenty-six con secutive patients scheduled for elective infrarenal aortic surgery. In terventions: The patients were prospectively randomised to receive 400 mg ibuprofen intravenously (i.v.) or a placebo aliquot before surgery . Measurements and 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 ton the 1st pos toperative day). At each point in time, we additionally registered hae modynamics and determined the plasma concentration of 6-keto-PGF(1 alp ha) (stable metabolite of prostacyclin, PGI(2)), bicyclic PGE(2) (stab le metabolite of PGE(1) E-2), active renin, aldosterone and vasopressi n by radioimmunoassays. Throughout the observation period the renal fu nction parameters mostly remained within the normal range without a si gnificant 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 postope rative day 43 +/- 5 vs 47 +/- 6 ml.min.m(-2), means +/- SEM). The plas ma levels of 6-keto-PGF(1 alpha) (68 +/- 8 vs 380 +/- 71 ng.l(-1)), b icyclic PGE(2) (57 +/- 5 vs 88 +/- 9 ng.l(-1)) and vasopressin (14 +/ - 7 vs 45 +/- 10 ng.l(-1), p < 0.0125), however, were significantly h igher during the intraoperative period in the placebo-treated patients . Conclusion: The inhibition of endogenous prostaglandin release by ib uprofen does not substantially impair renal function during infrarenal aortic surgery under EPA.