Lumbar pain is the most common skeletal and muscular complaint requiring medical care, which causes many complications and economic and social damages to the society and the fifth reason for visiting medical centers, especially for men. The aim of this study was to compare the effect of epidural injection of methylprednisolone, Bupivacaine and normal saline in chronic lumbar pain due to discal herniation. In a single-blind randomizedclinical trial performed in the Department of Anesthesia of Tabriz University of Medical Sciences on patients with chronic lumbar pain, the effect of epidural injections of methylprednisolone, Bupivacaine and normal saline in treatment of chronic lumbar pain due to discal herniation were studied. In this study, 84 patients with lumbar pain were treated and the effect of epidural injections of methylprednisolone, Bupivacaine and normal saline in treatment of chronic lumbar pain due to discal herniation were studied. The mean ages of patients in the methylprednisolone group, Bupivacaine group and normal saline group were 42.3 ± 12.20, 45.57 ± 11.59 and 42.64 ± 12.21 years respectively (P=0.503). In this study, the mean times to return to daily activities in patients in methylprednisolone group, Bupivacaine group and normal saline group were 56.00 ± 14.88, 55.11 ± 11.16 and 73.71 ± 35.13 hours respectively and the mean time to return to daily activities in patients in normal saline group was significantly higher (P=0.005). In this study, evaluating the therapeutic outcomes of epidural injection of methylprednisolone, Bupivacaine and normal saline were studied in patients with chronic lumbar pain due to discal herniation and the results show that epidural injections of methylprednisolone and Bupivacaine are more effective than placebo injection (normal saline) in these patients.
Paracetamol is a non-opioid analgesic that causes analgesia by serotonergic mechanism of action and inhibiting prostaglandin synthesis in the central nervous system. The usual dose of Paracetamol is 1g every 6 hours; however, this dosage does not afford enough postoperative analgesia. This study compared the effectiveness of 2g Paracetamol to usual 1g dosage in controlling gynecologic laparoscopic surgical pain. In this double blind randomized clinical trial, 30 patients aged 20-70 years with ASA class I or II of laparoscopic gynecologic surgery were studied. At the end of surgery, the study group (15 cases), received 2 grams of Paracetamol and the control group (15 cases) received 1g Paracetamol in 100ml normal saline solution within 15 minutes. The prevalence of abdominal pain and shoulder pain in recovery in study group were 4.34% and 00% in the control group was 47.82% and 4.34%, respectively (P<0.001 and P =0.013). The mean abdominal pain score in recovery in study group (0.07 ± 0.33) was significantly lower than in control group (2.01±1.62) (p˂0.001). The mean shoulder pain score in recovery in study group (0.00 ± 0.00) was significantly lower than in control group (1.53±0.55) (p˂0.018). Time to request for the first analgesic in the study group was longer (P=0.03). Liver tests in the 24 hours after surgery in both groups were not significantly different (p˃0.05). Prescription of Paracetamol 2g at the end of surgery, compared with 1gr dosage, can safely and effectively reduce the prevalence and scores of acute postoperative pain after gynecologic laparoscopic surgery.
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 10...
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