Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

Abstract

SUMMARY -Lumbar discectomy is the most common surgical treatment for intervertebral disc extrusion. Postoperative pain is a common clinical problem that greatly aff ects the length of hospitalization, functional status and patient quality of life. Th e aim of this study was to compare the postoperative analgesic effi cacy of paracetamol administered intermittently and through patient-controlled analgesia (PCA) pump following single level lumbar discectomy. Patients who underwent elective lumbar discectomy of intervertebral disc extrusion at the L4-L5 level diagnosed by magnetic resonance of the lumbosacral spine were included in the study. Pain was assessed at regular intervals for 48 hours through a shortened version of McGill pain questionnaire translated in the Croatian language. When pain was monitored as a summarized variable for each measurement, PCA group signifi cantly stood up after 24 hours with better perception of pain compared to the intermittent group (c 2 -test, p<0.05). Adequate pain relief is an important aspect of postoperative care in spinal surgery patients. Postoperative use of paracetamol through PCA pump achieved better pain control and pain management versus postoperative use of intermittent paracetamol analgesia after lumbar discectomy.

<p>Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review</p>

“…Postoperative pain relief was the third most common primary outcome of interest (n=13, 15% of included studies), 22 , 24 , 31 , 34 , 36 , 41 , 50 , 51 , 55 , 62 , 65 , 72 , 92 and a secondary outcome in 13 studies (15%). 35 , 40 , 47 , 52 , 60 , 69 , 75 , 76 , 79 , 81 , 86 , 87 Interventions of interest in the studies where pain was the primary outcome included hypnosis; 55 anaesthetic technique (for hysteroscopy); 51 play; 72 Reiki; 34 premedication and information; 50 different routes of paracetamol administration; 41 , 62 cold application; 65 guided imagery and relaxation; 22 positioning and early sandbag removal (post-coronary angiography); 92 room air versus carbon dioxide (CO 2 ) insufflation; 24 , 31 and bed positioning. 36 Nine studies had adult participants, 31 , 34 , 36 , 41 , 50 , 51 , 62 , 65 , 92 two were pediatric based, 55 , 72 and one study focused on adolescents.…”

“…107 Two studies focused on adolescents, 22 , 37 and one study included both adults and children. 84 Although older adults (>75 years) were included in some studies 52 , 60 , 62 they were not specifically identified as the target population in any of the included studies.…”

“…34,35,42,56,61,76,85,96 Almost half of the included studies assessed outcomes at multiple phases of the perioperative pathway (n = 34, 40%), whilst 24 studies (28%) assessed postoperative outcomes extending beyond the immediate PACU phase. 26,27,34,35,39,40,41,43,45,48,51,55,61,62,64,66,69,73,89,90,92,99,102,109 Five studies (6%) assessed outcomes only during the preoperative phase, 57,58,71,103,106 whilst only four studies assessed outcomes at a single phase of intraoperative care (n=4, 6%), 33,46,56,59,74 and seven studies assessed outcomes during PACU care only (n=7, 8%). 24,44,47,68,82,100,…”

Effect of Intravenous Paracetamol on Opioid Consumption in Multimodal Analgesia After Lumbar Disc Surgery: A Meta-Analysis of Randomized Controlled Trials

“…Thus, the performance of more well-conducted RCTs comparing different times of IV paracetamol used on postoperative analgesia is needed. Kurtovic et al (2017) compared the postoperative analgesic efficacy of intravenous paracetamol administered intermittently and through a patient-controlled analgesia (PCA) pump following lumbar discectomy. They found an interesting result, that patients in both groups had satisfactory pain control results.…”

Effect of Thunder-Fire Moxibustion for Lumbar Disc Herniation: Study Protocol for a Randomized Controlled Trial

“…Acetaminophen and NSAIDs are recommended as the rst-line medication options for most patients with low back pain (grade 1A evidence) in 2007 by the Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [ 6] . The e cacy of acetaminophen in the treatment of LDH has also been reported [ 7] , but it can only relieve pain and has no effect on other symptoms of LDH. However, acupuncture, massage and other complementary therapies have been widely used in the treatment of lumbar disc herniation [ 8] .…”