Role of intravenous paracetamol as an adjunct to epidural analgesia in immediate postoperative period in abdominal cancer surgeries (original) (raw)
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Background and purpose: Adequate postoperative pain management, intended not only to facilitate surgery, but also to prevent development of chronic pain, remains the prime concern of the anesthesiologists. Intravenous administration of paracetamol as preemptive analgesia for general surgery has not shown consistent outcomes. The purpose of the present study was to determine the effects of paracetamol as a preemptive analgesia in patients undergoing a major oncologic surgery.
Study of Paracetamol Infusion as Pre-Emptive Analgesic in Lower Abdominal Surgeries
IOSR Journal of Dental and Medical Sciences, 2017
Introduction: Pre-emptive analgesia is widely used to control intraoperative and postoperative pain. Intravenous Paracetamol, a non opioid analgesic gained wide popularity as to control pain during surgery. Present study is undertaken to check whether intravenous Paracetamol can be used as pre-emptive analgesic in patients undergoing lower abdominal surgeries under general anaesthesia. Methodology: 60 patients of ASA grade I & II undergoing lower abdominal surgeries under general anaesthesia were included in the study. Patients in the study group (n=30) received Paracetamol infusion (1000mg./100ml.) 15 minutes prior to induction of anaesthesia. All patients received uniform type of general anaesthesia and intra-operative fentanyl 2 mcg./kg. Monitoring includes Heart Rate (HR), Oxygen Saturation(SPO2), Blood Pressure. In the post operative period, pain is assessed at an interval of every 30 minutes till the first rescue analgesic. Pain is assessed using Visual Analogue Scale (VAS). The end point of the study is when rescue analgesic is administered to the patient. Result: Post operatively mean VAS score was better in the Paracetamol group compared to control group. Time requirement of first dose of rescue analgesic in the postoperative period was significantly prolonged in the Paracetamol group. Conclusion: It was concluded that IV Paracetamol is beneficial as a pre-emptive analgesic in patients who undergo lower abdominal surgeries.
2016
Introduction: Postoperative pain control plays a pivotal role in reducing postoperative complications, hospitality time, and increasing satisfaction. This study aimed to evaluate the effect of paracetamol on the pain and complications caused by gastrectomy. Materials and Methods: This randomized prospective study was conducted on 60 patients (two same group) who were candidate for gastrectomy in Imam Reza Hospital of Mashhad, Iran during August-September 2015. The first group received Patient-Controlled Analgesia (PCA) with morphine only, and in the second group, paracetamol (1 gram) infused with morphine every six hours. Level of pain, morphine intake, and side effects were evaluated in both groups. Results:No significant difference was observed in the four-scale score of pain in the patients (morphine group: 0.64±0.1, morphine-paracetamol group: 0.6±0.1) (P=0.72). During the first 24 hours after the surgery, the morphine group had lower consciousness level (2.3±0.2) compared to th...
Archives of anesthesiology, 2020
Background: Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gallbladder removal and is currently the most commonly performed major abdominal procedure in Western countries. Paracetamol is a medication used to treat pain and fever. It is typically used for mild to moderate pain relief. Also it is used for severe pain, such as cancer pain and pain after surgery, in combination with opioid pain medication. Objectives: The aim of the present study was to evaluate the effects of intravenous paracetamol treatment on early postoperative period analgesia after laparoscopic cholecystectomy. Subjects and Methods: Those patients were attending the general surgical unit in Sabratha Hospital. We conducted a case-control study of 20 patients underwent laparoscopic cholecystectomy as control group (aged 25 to 55 years; 13 males, 7 females) and their nearest-aged paracetamol group (aged 24 to 55 years; 14 males, 6 females). was used to assess severity of pain in all cases and controls. Pain evaluation was performed every 15 minutes after pain control was obtained. Results: There was a significant difference between cases and controls regarding all scores of Verbal Rating Scales. The verbal evaluation scores of the paracetamol group were significantly lower than the control group. Conclusion: It can be concluded that paracetamol is effective postoperative analgesia. It is the drug of choice in patients that cannot be treated with non-steroidal anti-inflammatory drugs. Pre-operative administration of paracetamol supports effective and faster recovery. Anticipatory guidance should be provided to encourage to use paracetamol as postoperative analgesia. Further studies are needed to clarify the postoperative recovery characteristics by Modified Aldrete's Scoring System.
Analgesic Effects of Paracetamol and Morphine After Elective Laparotomy Surgeries
Opioids have been traditionally used for postoperative pain control, but they have some unpleasant side effects such as respiratory depression or nausea. Some other analgesic drugs like non-steroidal anti-inflammatory drugs (NSAIDs) are also being used for pain management due to their fewer side effects. Objectives: The aim of our study was to compare the analgesic effects of paracetamol, an intravenous non-opioid analgesic and morphine infusion after elective laparotomy surgeries. Patients and Methods: This randomized clinical study was performed on 157 ASA (American Society of Anesthesiology) I-II patients, who were scheduled for elective laparotomy. These patients were managed by general anesthesia with TIVA technique in both groups and 150 patients were analyzed. Paracetamol (4 g/24 hours) in group 1 and morphine (20 mg/24 hours) in group 2 were administered by infusion pump after surgery. Postoperative pain evaluation was performed by visual analog scale (VAS) during several hours postoperatively. Meperidine was administered for patients complaining of pain with VAS > 3 and repeated if essential. Total doses of infused analgesics, were recorded following the surgery and compared. Analysis was performed on the basis of VAS findings and meperidine consumption. Results: There were no differences in demographic data between two groups. Significant difference in pain score was found between the two groups, in the first eight hours following operation (P value = 0.00), but not after 12 hours (P = 0.14) .The total dose of rescue drug (meperidine) and number of doses injected showed a meaningful difference between the two groups (P = 0.00). Also nausea, vomiting and itching showed a significant difference between the two groups and patients in morphine group, experienced higher levels of them. Conclusions: Paracetamol is not enough for postoperative pain relief in the first eight hour postoperatively, but it can reduce postoperative opioid need and is efficient enough for pain management as morphine after the first eight hours following surgery.
Global Journal of Health Science, 2013
Objective: postoperative pain increases the activity of the sympathetic system, causes hypermetabolic conditions, retains salt and water, increases glucose, fatty acid lactate and oxygen consumption, weakens the immunity system which delays wound healing. Our object was comparison of the analgesic effect of morphine and paracetamol in the patients undergoing laparotomy, using PCA method. Method: Seventy patients who had undergone laparotomy were studied using double blind randomized clinical trial (35 patients received morphine and 35 paracetamol) in the Shahid Rajaee Center and Velayat Hospital (Qazvin, Iran). People using opioids, painkillers and sedatives regularly and in large doses and patients with a history of lung or liver problems did not participate in this project. The parameters of the severity of pain and nausea (VAS), hemodynamic changes (BP and HR), pruritus, arterial oxygen desaturation and patient satisfaction (VAS) of both groups were measured by a third party (trained colleague). The data was analyzed using SPSS 16 statistical software then descriptive results were extracted and ultimately the groups were compared using the following statistical tests: student's T-test, chi 2 and Fisher's exact test (P<0.05). Findings: The mean age of the participants was 45±12.5 years. Women constituted 24.3% of the patients and men 75.7%. The average pain severity for morphine and paracetamol groups (VAS) was 5.3±2.2and 6.37±1.7 after2 hours and reached 1.91±1.3 and 2.49±1.3 after 8 hours (after the operation) respectively. There was a significant difference between the groups after 2 and 4 hours in terms of pain severity (after 2 hours P=0.007 and after 4 hours P=0.047). However there was no significant difference between the average pain severity of the studied groups (after 6 hours P=0.4 and 8 hours P=0.08). After 8 hours, the average nausea severity was the minimum in both groups being 1.71±1.6 and 1.43±1.1 in morphine and paracetamol groups respectively. Nausea severity was higher after 2 hours in paracetamol group. In morphine group, it was higher after 4, 6 and 8 hours. Difference between the groups was not significant. The average satisfaction level (VAS) for morphine and paracetamol groups reached from 5.29±2.3 and 4.2±2.4 after 2 hours, to 7.94±1.8 and 7.69±2.1 after 8 hours (after the operation), respectively. The average satisfaction level of patients was higher in morphine group in 2,4,6 and 8 hours and except for, after 4 hours (P=0.01), the satisfaction difference between both groups was not significant in other hours (P=0.06 after 2 hours, P=0.6 after 6 hours and P=0.5 after 8 hours) Conclusion: Morphine seems to be more effective at 2 and 4 hours, but after 4 hours they have similar effects, the satisfaction difference between both groups was not significant in the patients.
Effect of Different Doses of Paracetamol on Postoperative Pain After Gynecologic Laparoscopy
International Journal of Women's Health and Reproduction Sciences
Introduction Laparoscopic surgery is a minimally invasive technique associated with less postoperative pain. However, laparoscopic procedures are associated with moderate to severe postoperative pain, frequently in abdomen or shoulder regions in most patients, particularly on the first postoperative day. Studies show that 80% of patients require systemic opioid analgesia after laparoscopic surgery (1,2). Different approaches have been recommended for the treatment of postoperative pain. Systemic, local, and neuraxial medications (as preemptive, preventive, or postoperative administration) are the commonly used modalities for postoperative pain relief (3-5). However, they may not completely relieve postoperative pain, and/ or have the potential for debilitation and serious adverse reactions (3-8). Paracetamol is used as a supplemental analgesic or single modality to reduce postoperative pain. Paracetamol takes both central inhibitor action on cyclooxygenases (cox-3) and interaction with the serotonergic system. In addition, paracetamol is a weak cox-1 and cox-2 inhibitor (anti-inflammatory effect). Moreover, paracetamol does not have the adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids (9-12). Paracetamol (intravenous acetaminophen) is a nonopioid analgesic which is devoid of risks related to opioids (10). The usage of paracetamol after various surgical procedures in decreasing acute pain has been shown (11,12). The mechanism of action is not completely understood; it is thought to act through the inhibition of prostaglandin synthetase in the CNS (13). The combination of paracetamol with other analgesics working on different pain mechanisms may be an improvement in postoperative analgesia and reduction of side effects (9). The recommended dose for paracetamol in adults is 1 g, which can be administered every 6 hours per day (14). There are conflicting results concerning the analgesic effect of paracetamol 1 g in postoperative pain control, especially severe pain. Likewise, there is limited information on using a high starting dose of paracetamol for postoperative pain control (15-17). In addition, no other study on the preventive administration of larger doses of paracetamol for the management of laparoscopic pain is available. In a previous study, we found advantages of administration of 1 g of paracetamol at the end of surgery (preventive analgesia) in the patients undergoing cesarean section (18). Thus, this study was designed to evaluate the analgesic efficacy and opioid-sparing activity of 2 g of paracetamol compared with 1 g at the end of Abstract Objectives: This study aimed to investigate the analgesic efficacy and safety of preventive administration of 2 g of paracetamol compared with 1 g for the management of postoperative pain in the patients undergoing gynecologic laparoscopic procedures. Methods and Materials: This double-blind study was conducted on 92 women who were randomly assigned into two groups: paracetamol 2 g (study group; n=46) and 1 g (control group; n=46) into 100 mL normal saline, infused over 15 minutes in the end of surgery. Abdominal and shoulder pain scores were recorded in post-anesthesia care unit (PACU), 1, 2, 3, 6, 12, and 24 hours after the operation. The time of first request for analgesic and the values of liver enzymes were recorded. Results: During 24 hours after surgery, the prevalence of postoperative abdominal pain was 52.17% and 89.13% (P < 0.001) and shoulder pain was 6.52% and 23.91% (P = 0.039) in the study and control groups, respectively. Abdominal pain score (0.06±0.32 vs. 1.6±2.0; P < 0.001) and shoulder pain score (0.0 ± 0.0 vs. 0.50±1.37; P = 0.017) in PACU were lower in the study group compared to the control group. The time to first request for analgesic was significantly longer in the study group than that in the control group (P = 0.030). There was no significant difference in liver enzyme values in postoperative 24 hours between the groups (P > 0.05). Conclusions: Administration of both doses of paracetamol at the end of surgery was effective on postoperative pain; however, the best pain relief was obtained by paracetamol 2 g with no side effects.
Pain medicine (Malden, Mass.), 2017
Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Prospective, randomized, double-blind. Academic medical center. Ninety ASA I-III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 mL volume and 0.3 mg morphine in 1 mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1 mL volume instead of morphine. The morphine + ketamine group (group K + M) received both 0.3 mg morphine and 0.1 mg/kg ketamine in 1 mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Total PCA morphine was significantly decreased in group M + K compared with groups M and K. Time to first r...
Anesthesiology and Pain Medicine, 2015
Background: Major surgical procedures, such as gastrectomy, result in extensive postoperative pain, which can lead to increased morbidity, discomfort and dissatisfaction among the patients. Objectives: The aim of this study was to evaluate the effect of adding diclofenac suppositories or intravenous paracetamol, on morphine consumption and on the quality of postgastrectomy pain control. Patients and Methods: This randomized double blinded clinical trial was carried out in 90 patients with gastric cancer, who were candidates for gastrectomy, which were divided into three similar groups. The patients were transferred to an intensive care unit after the operation and received patient-controlled analgesia (PCA) with morphine, morphine PCA plus intravenous paracetamol 1 g, every 6 hours, and morphine PCA plus diclofenac suppositories, 100 mg every 8 hours. The patients were evaluated for up to 24 hours after the operation for the severity of pain, alertness, and opioid complications. Results: There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001). In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups. Conclusions: In this study, intravenous paracetamol or diclofenac suppositories, administered for postgastrectomy pain control, decreased morphine consumption by almost 32% and also improved alertness. Nevertheless, the amount of opioids did not affect the incidence of complications.
INDIAN JOURNAL OF APPLIED RESEARCH, 2023
Background: Unrelieved post-operative pain may result in the physical suffering as well as multiple physiological and the psychological consequences, which may adversely affect the peri-operative outcome and contribute to increase the length of stay in hospital. Objectives: We designed this study to evaluate the effect of IV Paracetamol and Dexmedetomidine as multimodal analgesic technique on post-operative analgesia and to reduce the consumption of the systemic opioid and its adverse effects in cases of laparoscopic cholecystectomy. Materials and Methods: Eighty consenting, American society of Anesthesiologist-physical status-I (ASA-PS-I), female patients, aged 19-60 year was randomly assigned to one of the following two groups: Group P (n = 40) received IV 1 g Paracetamol infusion over 10 min pre-operatively and 6 hourly thereafter and Group D (n = 40) received IV Dexmedetomidine 1 μg/kg bolus over 10 min pre-operatively and 0.2-0.4 μg/kg/h thereafter for 24 h. Peri-operative hemodynamic variables, post-operative pain scores, and the need for rescue analgesics were recorded and compared. Results: Profi les of intra-operative hemodynamic changes were similar in both groups in respect to heart rate (HR), diastolic blood pressure, mean arterial pressure except in the systolic blood pressure where Dexmedetomidine signifi cantly reduced it in compare to Paracetamol (P = 0.014). Post-operatively 4 th h and 24 th h changes in mean HR between two groups was a statistically signifi cant (P < 0.05). Visual analog scale scores were signifi cantly lower in the Group P compared with Group D at 8 th , 16 th , and 24 th h (P < 0.001). Sedation score were statistically higher in the Group D compared with the Group P at post-operative 4 th , 8 th , 16 th , and 24 th h (P < 0.006). Conclusion: Adjunctive use of both Paracetamol and Dexmedetomidine infusion reduced opioid use. However, Paracetamol peri-operatively provides adequate analgesia with the less sedation whereas Dexmedetomidine provides analgesia and cooperative sedation.