Comparative evaluation of efficacy of intravenous paracetamol and intravenous diclofenac as post-operative analgesia in laparoscopic cholecystectomy

Abstract

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.

Comparison of Analgesic Effects of Paracetamol and Ibuprofen After Laparoscopic Cholecystectomy

“…A study on patients who had undergone laparoscopic cholecystectomy concluded that the 24-h postoperative pain management was better with perioperative paracetamol than that with perioperative diclofenac administration. 23 Another study on patients who had undergone cesarean section reported similar postoperative pain scores with preoperative 1 g of IV paracetamol and 400 mg of oral ibuprofen. 24 IV ibuprofen (800 mg) is more effective than IV paracetamol (1 g) in reducing renal colic pain.…”

“…All statistical analyses were performed with IBM SPSS ver. 23 Table 1. There was no significant difference between the groups in terms of age, sex, weight, BMI, ASA scores, duration of surgery, and duration of anesthesia.…”

A comparative evaluation of analgesic effects of using intravenous paracetamol versus intravenous diclofenac post-operatively in laparoscopic cholecystectomy patients in SMIH, department of surgery, Dehradun

“…With reference to previous studies, our study was in contrast with those of Goel et al, who found significant variation in mean changes of pulse rate between the groups from 1-4 hours after surgery. 12 [13][14][15][16] In case of systolic blood pressure (SBP), it was found that mean of Paracetamol group was lower than that of diclofenac group in all studies. [12][13][14] Moreover, in study by Goel et al, difference of SBP was found in both groups after 4 hours of study.…”

“…This may be due to better pain control in Paul et al did not found any significant difference in both groups except at 12 hours. 16 This can be attributed to inhibitory effect of Diclofenac on cyclooxygenase pathway preventing the conversion of arachidonic acid to PG and thromboxane.…”

“…14 Paul et al attributed this to better pain control in PCM group as compared to diclofenac group. 16…”