Study of Paracetamol Infusion as Pre-Emptive Analgesic in Lower Abdominal Surgeries (original) (raw)
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IP Innovative Publication Pvt. Ltd., 2018
Aims and Objectives: To evaluate analgesic efficacy and side effects of intravenous paracetamol, also assess IV-PCA morphine consumption in patients undertaken abdominal cancer surgery. Materials and Methods: Total 160 ASA grade I and II patients of both the sex, between age 18-70 years were randomly divided in two equal groups to receive either IV paracetamol 1gm or no paracetamol after surgery. Hemodynamic parameters, pain intensity scores, amount of morphine consumption and side effects were recorded. Results: The control group had higher mean heart rate, mean arterial blood pressures, mean respiratory rate than paracetamol group. Pain intensity score was much higher in control group at any time which needed considerably higher dose of rescue analgesic (IV morphine) for pain control than paracetamol group. We found no significant difference statistically in sedation scores in patients using patient controlled analgesia in either group. Side effects were found to be lower in paracetamol group compared to control group but difference was not significant statistically. Conclusion: Paracetamol is safe and effective drug for postoperative analgesia with negligible side effects. Keywords: IV paracetamol, IV-PCA morphine, Abdominal cancer surgery, Epidural Analgesia, Pain scores, Sedation score.
2019
Introduction: Post operative pain after surgery is a cause of significant morbidity and patient dissatisfaction. In this study we try to compare efficacy between 1 gram acetaminophen oral dose with 1 gram acetaminophen intravenous dose in controlling post operative pain. Material and methods: This study is a prospective, randomized and comparative study conducted at NRI institute of medical sciences, Visakhapatnam between Oct 2016 to October 2017. 90 patients belonging to ASA status I and II of both genders, age group-18 to 60 years and undergoing surgeries under general anaesthesia lasting less than 2 hours were enrolled for the study. 2 groups out of which Group A received 1gm oral paracetamol and Group B received 1gm intravenous paracetamol. The grous were compared post operatively for pain scores at 30, 60, 90, 120, 150 minute after surgery using visual analogua scale(VAS) results: The mean VAS scores were 2.78, 4.07, 5.81, 6.36, 6.5 for Group A and 2.18, 3.5, 4.76, 6.04, 6.43 for Group B. Thus pain scores were consistently lesser in Group B than Group A. Pain scores were significantly lower in Group B during the time period 30 mins and 90 mins (p values 0.039 and 0.002 respectively). The time of first rescue analgesia (i.e, Fentanyl) was compared in both the groups. Mean for time of demand for analgesia was 88.67 mins and 102 mins in Group A and Group B respectively. P value was 0.05 thus a significantly earlier requirement of rescue analgesia in Group A. Conclusion: The rescue analgesic requirement was significantly lesser in intravenous acetaminophen group. Hence 1gm intravenous paracetamol is superior to oral formulation in controlling post operative pain.
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.
Journal of Evolution of Medical and Dental Sciences, 2019
Pre-emptive analgesia is administration of an analgesic before a painful stimulus, so as to prevent central sensitisation. Intravenous (IV) formulation of paracetamol has been introduced and its safety and pharmacokinetic properties have been established for children providing excellent analgesia and avoiding side effects associated with opioids and non-steroidal antiinflammatory drugs. Present study was done to compare the analgesic effects of pre-emptive I.V. paracetamol and tramadol in children undergoing lower abdominal surgeries. Sixty-four children of ASA physical status I and II, aged 2 to 12 years scheduled for elective lower abdominal surgeries under general anaesthesia were recruited for a prospective, randomized controlled, double blinded study, into group P and group T. Following induction, group P received 15 mg/ kg I.V. paracetamol and group T 1 mg/kg tramadol in 75 ml of normal saline over 15 minutes before surgical stimulus. Postoperative modified objective pain scale (OPS), time to first rescue analgesia (FRA), Aldrete score, time to reach Aldrete score> 9, sedation scores, parent satisfaction scores and PONV were recorded for 24 hours. Mean pain scores by OPS in group P and T were similar and statistically insignificant. Time to FRA being 320 ± 20 min in group P as compared to group T 340 ± 30 min. 12.5% patients had PONV in group P as compared to 81.5% in group T (p≤0.05). Mean duration to reach Aldrete score of 9 was 11 ± 1.5 min and 16.7 ± 3 min in group P and T respectively (p≤0.05). Pre-emptive I.V. paracetamol is as efficacious as I.V. tramadol for postoperative analgesia with early recovery and lower incidence of PONV in paracetamol group.
International Surgery Journal, 2016
Pain is a most common symptom of any illness. The international association for the study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". 1 Major abdominal surgeries with upper abdominal incision lead to severe postsurgical pain, which if treated inadequately, can cause shallow breathing, atelectasis, and retention of secretions and lack of cooperation during physiotherapy. This increases the incidence of post-operative morbidity and leads to delayed recovery. 2 Management of acute post-operative pain has been given more importance in recent years with considerable concurrent advancement in this regard. Despite this advancement, post-operative pain continues to be a challenge and often leads to patient dissatisfaction. 3,4
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.
IP Innovative Publication Pvt. Ltd., 2018
Introduction: The recommended approach for postoperative pain management is to initiate the treatment with analgesics such as paracetamol, NSAIDS, and aspirin followed by adjunctive use of opioids to treat more acute pain symptoms. However, the adverse effects associated with opioids and NSAIDS are well established. Aim: To study the efficacy of paracetamol in comparison to Tramadol when used as analgesic component of balanced anesthesia, pre-emptively for intraoperative and postoperative purpose. To study their side effects. To find out which of these two drugs is better in providing intraoperative and postoperative analgesia with minimum side effects. Materials and Methods: 60 patients of either sex, divided using computer generated random number table into 2 equal groups. Group T: (n 30): Tramadol hydrochloride group, Group P: (n 30): Paracetamol group. The dose of paracetamol and tramadol hydrochloride was 15mg/kg and 2mg/ kg body weight respectively. Statistical analysis: analysis was done by SPSS software version 11 by using Z test, chi-square test, proportion test (Z). P value less than 0.05 was considered as significant and less than 0.0001 as highly significant. Results: Both the groups were comparable with respect to their demographic profile, ASA status, and surgical procedures. Both paracetamol and tramadol have a good analgesic action and fewer side effects. The mean score of VAS Scale in group P (1.86  2.40) and group T (3.03  2.42) was similar and difference was not statistically significant. Also the side effects were comparable in both groups. Total number of rescue analgesics required by the group P (1.6) was significantly less as compared to the group T (3.7) with Z value = 4.00, p < 0.0001. Conclusion: Paracetamol has a better efficacy than tramadol hydrochloride in providing intra-operative and post-operative analgesia, when used pre-emptively with reduced number of doses of analgesic and almost no side effects. Keywords: Analgesia, Paracetamol, Post-operative Preemptive, Tramadol.
BMC Anesthesiology, 2020
Background In the practice of postoperative pain management, pain is still poorly managed in low resource setting where the practice of epidural and opioid free analgesia is impractical. There has been a recent trend of combining different drugs and concept of preemptive analgesia but the therapeutic superiority remains understudied for postoperative pain management. The aim of this study is to assess postoperative analgesic effect of preemptive Paracetamol, Paracetamol-diclofenac and Paracetamol-tramadol combination in patients undergoing laparotomy surgery. Methods Three-arm, randomized control trial study conducted on 63 patients undergone laparotomy surgery; group-P (paracetamol 1 g), group-PD (1 g + diclofenac 75 mg) and group-PT (paracetamol 1 g + tramadol 100 mg). The Numerical Rating Scale (NRS) pain rating system was used for this study. The primary endpoint of the study was total amount of analgesia consumption. Post-operative analgesic therapy [intravenous tramadol, 50 mg...
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.
Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: Dilatation and Evacuation procedure involves pain, for which pain control measures need to be undertaken. The purpose of this study was to compare paracetamol with fentanyl for pain relief in dilatation and curettage procedures. Materials and Methods: Sixty female patients were randomly included during the period from March 1, 2012 to February 28, 2013. All patients had received oral midazolam 7.5 mg as a premedication 30 min before procedure in the ward. Group P had received intravenous (IV) paracetamol 15 mg/kg in the waiting area of the operating room 15 min before starting the procedure. Group F had received IV fentanyl 2 ug/kg/min at induction of anesthesia. Pain scores on a numerical rating scale at 5, 15, and 30 min intervals after surgery were recorded. Results: Mild pain was commonly observed in both groups, an insignificant difference between groups. Conclusion: The study demonstrates the usefulness of IV paracetamol which may be as effective as fentanyl in dilation and curettage procedures.