Cocoa vs Ibuprofen as Paracetamol Adjuncts for Postoperative Pain and Inflammation in Femoral Fracture Rats

Abstract

Background: The management of acute postoperative pain commonly relies on multimodal regimens combining paracetamol with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. These approaches may pose adverse effects, highlighting the need for safer adjuvant alternatives. Cocoa, rich in polyphenols and flavonoids, shows potential as an anti-inflammatory and analgesic agent. Objectives: To compare the efficacy of cocoa and ibuprofen as adjuvants to paracetamol in reducing acute pain and plasma interleukin-1 beta (IL-1β) levels in a rat model of postoperative femoral fracture. Methods: Eighteen healthy male Wistar rats (150–300g, 16–24 weeks) were randomized into three groups (n=6): control (placebo), cocoa-paracetamol, and ibuprofen-paracetamol. Standardised femoral fracture surgery was performed under anaesthesia, followed by assigned treatments. Pain evaluation was performed 24 hours postoperatively using the Von Frey filament test; plasma IL-1β was measured by ELISA. Data were analyzed using ANOVA and post-hoc Tukey test (p<0.05). Results: IL-1β levels were significantly lower in the cocoa-paracetamol (2.50±0.89ng/ml) and ibuprofen-paracetamol (4.32±0.52ng/ml) groups compared to control (7.41±0.65ng/ml; p=0.000). Cocoa-paracetamol showed significantly lower IL-1β than ibuprofen-paracetamol (p=0.001). Von Frey scores were significantly higher (indicating better analgesia) in the cocoa-paracetamol (19.38±4.15gf) and ibuprofen-paracetamol (26.19±8.01gf) groups than control (9.52±1.63gf; p<0.001); there was no statistically significant difference between cocoa-paracetamol and ibuprofen-paracetamol (p=0.098). IL-1β levels and Von Frey scores were moderately negatively correlated (r=–0.529, p=0.024). Conclusion: Cocoa as an adjuvant to paracetamol provided analgesic efficacy comparable to ibuprofen and superior anti-inflammatory effect as assessed by IL-1β. Cocoa is a promising, safer adjuvant alternative to NSAIDs for postoperative pain management.