A Preliminary Examination of the Comparative Efficacy of Intravenous vs Oral Acetaminophen in the Treatment of Perioperative Pain (original) (raw)
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Electronic Physician
Introduction: In laparoscopic surgery, insufflation of CO2 gas into the peritoneal cavity creates referred postoperative pain and diffuse abdominal pain. Referred pain is sometimes more intensive than incisional and abdominal pain. Objective: To determine the efficacy of acetazolamide by increasing pH and reducing acidity in the abdomen and to compare the analgesic effects of paracetamol and acetazolamide with a control group in laparoscopic surgery. Methods: This randomized, double-blind, parallel-controlled clinical trial was conducted on ASA1 (American Society of Anesthesiologists Class 1) patients, who were candidates for laparoscopic cholecystectomy in teaching hospitals affiliated with Mashhad University of Medical Sciences during 2016-2017. One hundred fourteen patients were allocated equally into two study groups and one control group (receiving acetazolamide, paracetamol, or placebo). In the acetazolamide group, 250 mg acetazolamide was administered one hour before anesthesia. In the paracetamol group, 1 g paracetamol was infused over a 15-min postanesthesia induction. Incision site, diffuse abdominal, and shoulder pains were evaluated at the recovery room the day after surgery and upon hospital discharge using a numeric rating scale (NRS). Data were analyzed by SPSS 16.0, using Chi-square for trend test, Fisher's exact test, paired-samples t-test, Wilcoxon signed-rank test, two-way repeated measure analysis of variance (ANOVA), and Mann-Whitney U test. Results: There were no significant differences between groups regarding their demographic characteristics. The acetazolamide group exhibited a lower frequency of shoulder pain than the paracetamol and control groups at recovery (p=0.03), 24 hours later (p=0.001), and before discharge (p=0.014). Incisional and diffuse abdominal pains were lower in the paracetamol group (p=0.012). Conclusion: In the patients undergoing laparoscopic cholecystectomy, acetazolamide was effective in the reduction of shoulder pain and paracetamol was effective in postoperative incisional and abdominal pain control. Registration: This study was registered In the Iranian Registry of Clinical Trials under registration number IRCT201206108384N2.
International Journal of Anesthesiology & Pain Medicine, 2018
Background: Surgical and laparoscopic techniques are two different methods for the removal of gall bladder. Today, laparoscopic cholecystectomy is a preferred method for short-term hospitalization and early return to function related to minimal invasive surgical technique. However, patients still complain of significant postoperative pain, secondary inflammation of the diaphragm and the nociceptive genus of the annoying membrane's peritoneum. Multimodal analgesia is necessary for managing pain after laparoscopic cholecystectomy. Magnesium sulfate is a new emerging medication for the management of acute pain. There are no previous reports to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride and bupivacaine plus magnesium sulfate for postoperative pain after laparoscopic cholecystectomy. Aim: The purpose of this study is to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride versus bupivacaine plus magnesium sulfate in patients undergoing laparoscopic cholecystectomy under general anesthesia for better pain relief and less opioid consumption during the first 24 hours. Methods: Following the approval of the Institutional Review Board of An-Najah National University and written informed consent from patients undergoing laparoscopic cholecystectomy, hundred patients between 18 and 60 years old, American Society of Anesthesiologist (ASA) Grades I and II, were randomized to one of the following groups by the sealed envelope: (Mo group) (n=50) receiving intraperitoneal instillation of 30 ml 0.25% bupivacaine and 3 mg morphine and (Mg group) (n=50) receiving intraperitoneal instillation of 0.25% bupivacaine plus 50 mg/kg magnesium sulfate to a total volume of 30 ml. Medications were given after peritoneal wash and suctioning through intraperitoneal instillation. A drug solution is prepared by a doctor who does not participate in the study. All patients received the same anesthesia method, general anesthesia was administered. The induction protocol was standard for all patients. Patients were monitored for electrocardiogram (ECG), heart rate, blood oxygenation (SpO 2 %) and noninvasive blood pressure (NIBP). Postoperative pain was evaluated using visual analog scale (pain score of 0-10). The participants were evaluated for 24 hours after the operation with the registration of abdominal pain. The postoperative pain outcome was reported at 0 and 30 min, 1, 4, 8, 12, 16 and 24 hours. The cutoff value for VAS is 4 for indication of rescue medication. At VAS ≥ 4, rescue analgesics were administered on request (20 mg of pethidine) intravenously in Post Anesthetic Care Unit (PACU) and 50 mg intramuscularly in the surgical ward.
International Journal of Biomedical Research, 2015
Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p-value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.
Background: Effective control of postoperative pain reduces the postsurgical discomfort and facilitates early ambulation. We evaluated the efficacy of trocar sites and intra peritoneal administration of bupivacaine in reducing the postoperative pain and analgesic requirement. Materials and methods: Sixty adult ASA physical status Ι to ΙΙΙ patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either, 30 ml of 0.25% bupivacaine at gall bladder bed plus 20 ml of 0.25 % bupivacaine at trocar sites (Group B) or an equal volume of normal saline (Group S). Postoperative pain was assessed using 10 point Visual analogue scale every four hours for 12 hours. The total analgesic consumption in 12 hours was also assessed. Results: The mean pain total pain score were significantly less (< 0.0001 ) in Group B (2.03±0.9289) when compared to Group S (4.266±0.4767). Total tramadol consumption decreased by 56% in Group B (113.33 ± 34.57mg) compared to Group S (256.66 ± 50.4 mg).The variation was statistically significant(p < 0.0001). Total consumption of diclofenac was significantly (p < 0.0001) less in Group B than Group S (7.5±22.884 Vs 55±33.733mg). Conclusion: Local anaesthetic administration is an effective component of multimodal analgesia for reducing postoperative pain and opioid requirement after laparoscopic cholecystectomy
International Surgery Journal, 2019
Background: Post-operative adequate analgesia plays an important role in early mobilization, short hospital stay and patient satisfaction in laparoscopic cholecystectomy. The use of opioids for providing postoperative analgesia has been marked by side effects like vomiting, nausea, sedation, respiratory distress, etc. hence, alternate drugs like paracetamol (PCM) and diclofenac are commonly used. In this study, we have compared the analgesic efficacy and any associated side effects of the two commonly used non-opioid NSAIDS namely paracetamol and diclofenac. Methods: We compared 50 patients undergoing laparoscopic cholecystectomy in ASA I and II. They were randomly divided into two groups, Group A and Group B. Group A was administered intravenous PCM and Group B was administered injection diclofenac sodium. Postoperatively, these patients were assessed for pain, blood pressure, respiratory rate, and presence of any side effects like nausea, vomiting or any respiratory discomfort. Results: The mean DBP, MAP and VAS score was significantly (p-value <0.05) in Group A as compared to Group B patients at 4, 8, 12 and 24 hours postoperatively. There was no statistically significant difference in mean SBP and O 2 saturation in both groups. The mean pulse rate was lower in Group A as compared to Group B at 8, 12 and 24 hours. Conclusions: This study concluded that postoperative PCM infusion provided better analgesia for a prolonged period of time with minimal side effects.
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.
Indian Journal of Clinical Anaesthesia
Pre-emptive paracetamol has been shown to decrease postoperative analgesia requirement in many patient populations; however evidence supporting its role in laparoscopic cholecystectomy is lacking. Our aim was to determine the effect of Pre-emptive paracetamol on post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Ninety patients belonging to American Society of Anesthesiologists physical status I or II were randomly assigned to 3 groups. Group I received 1 gram of paracetamol intravenously 30 min prior to surgery; Group II received 1 gram of paracetamol intravenously intraoperatively at time of skin closure and Group III was the control group and did not receive any paracetamol. The postoperative pain scores by VAS and analgesia requirement was compared in the 3 groups’ upto 6 hours postoperatively. The postoperative pain scores remained comparable in the 3 groups for most of the duration of study. The post-operative fentanyl consumption was sig...