Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine

Siddik, Sahar; Aouad, Marie T.; Jalbout, Maya I.; Rizk, Laudia B.; Kamar, Ghada H.; Baraka, Anis

doi:10.1053/rapm.2001.21828

Cited by 64 publications

(66 citation statements)

References 33 publications

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“…In fünf Studien erfolgte die Gabe der Studienmedikation an mehreren postoperativen Zeitpunkten [15,19,23,26,34] und in drei Studien lediglich an einem postoperativen Zeitpunkt [3,6,25]. Zwei Studien hatten eine zusätz-liche Studiengruppe, in der ausschließ-lich Placebo appliziert wurde [23,34]. In sämtlichen Studien war die postoperative Schmerzintensität die Hauptzielgrö-ße.…”

Section: Paracetamol/propacetamol + Diclofenac Vs Paracetamol/ Propaunclassified

“…Acht Studien untersuchten zudem den Opioidbedarf in der postoperativen Phase als zweiten Endpunkt [3,6,15,19,23,25,26,34]. Eine davon wurde als positiv bewertet [6], demgegenüber stehen fünf Studien mit negativem Ergebnis [15,23,25,26,34]. Zwei Studien wurden nicht bewertet [3,19].…”

Section: Paracetamol/propacetamol + Diclofenac Vs Paracetamol/ Propaunclassified

“…Im Vergleich der Kombination mit Paracetamol/Propacetamol konnten alle der acht Studien einen Vorteil der Kombination bezüglich der Schmerzintensitäten zeigen, davon sechs zumindest in gewissen Zeitintervallen mit statistischer Signifikanz [3,6,19,23,26,34]. Auch beim Opioidbedarf schnitt die Kombination besser ab, in vier der sechs Studien zumindest zeitweise auf signifikantem Niveau.…”

Section: Vergleich Der Kombination Mit Alleiniger Paracetamolgabeunclassified

“…In sechs Studien wurde die Kombination zusätzlich mit Diclofenac als Monoanalgetikum verglichen [6,15,23,25,26,34]. Nur in einer Studie konnten geringere Schmerzintensitäten registriert werden, die zudem auch statistisch signifikant waren [6].…”

Section: Vergleich Der Kombination Mit Alleiniger Diclofenacgabeunclassified

“…Nur in einer Studie konnten geringere Schmerzintensitäten registriert werden, die zudem auch statistisch signifikant waren [6]. In vier der sechs Studien war auch der Opioidbedarf Zielgröße [15,25,26,34]. Alle vier Studien zeigten einen reduzierten Opioidbedarf in den Kombinationsgruppen, wenngleich statistisch nichtsignifikant.…”

Section: Vergleich Der Kombination Mit Alleiniger Diclofenacgabeunclassified

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Combined analgesics for postoperative pain therapy

Lange

Kranke

Steffen³

et al. 2007

Anaesthesist

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Section: Paracetamol/propacetamol + Diclofenac Vs Paracetamol/ Propaunclassified

Section: Vergleich Der Kombination Mit Alleiniger Paracetamolgabeunclassified

Section: Vergleich Der Kombination Mit Alleiniger Diclofenacgabeunclassified

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Combined analgesics for postoperative pain therapy

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Kranke

Steffen³

et al. 2007

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Effectiveness of Acupuncture for Pain Control After Cesarean Delivery

et al. 2022

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IMPORTANCE A pharmacological approach to pain control after cesarean delivery is often insufficient on its own. Acupuncture is a promising method for mitigating postoperative pain and reducing postoperative opioid requirements. OBJECTIVE To evaluate the efficacy and effectiveness of acupuncture as an adjunctive therapy for pain control after cesarean delivery, compared with a placebo intervention and standard care alone. DESIGN, SETTING, AND PARTICIPANTSThis single-center, placebo-controlled, patient-and assessor-blinded randomized clinical trial was conducted from January 13, 2015, to June 27, 2018, at a tertiary university hospital in Greifswald, Germany. Participants were women who were scheduled for elective cesarean delivery under spinal anesthesia and were randomized to either the acupuncture group (n = 60) or placebo group (n = 60). Another 60 consecutive patients who met the eligibility criteria and received the standard postoperative analgesia were selected to form a nonrandomized standard care group. The intention-to-treat analysis was performed from August 19, 2019, to September 13, 2019. INTERVENTIONSIn addition to standard pain treatment, each patient in the acupuncture group received auricular and body acupuncture with indwelling intradermal needles, whereas patients in the placebo group were treated with nonpenetrating placebo needles. MAIN OUTCOMES AND MEASURESThe primary outcome was pain intensity on movement, which was measured using an 11-item verbal rating scale. Secondary outcomes were analgesia-related adverse effects, analgesics consumption, time to mobilization and Foley catheter removal, quality of patient blinding to randomization, and patient satisfaction with treatment of pain. RESULTSA total of 180 female patients (mean [SD] age, 31 [5] years) were included in the intentionto-treat analysis. The mean pain intensity on movement in the acupuncture group on the first postoperative day was lower than in the placebo group (4.7 [1.8] vs 6.0 [2.0] points; Cohen d, 0.73; 95% CI, 0.31-1.01; P = .001) and the standard care group (6.3 [1.3] points; Cohen d, 1.01; 95% CI, 0.63-1.40; P < .001). On the first postoperative day, 59 patients (98%) in the acupuncture group were fully mobilized vs 49 patients (83%) in the placebo group (relative risk [RR], 1.18; 95% CI, 1.06-1.33; P = .01) and 35 patients (58%) in the standard care group (RR, 1.69; 95% CI, 1.36-2.09; P < .001). The Foley catheter was removed in a total of 57 patients (93%) from the acupuncture group vs 43 patients (72%) from the placebo group (RR, 1.33; 95% CI, 1.12-1.57; P = .003) and 42 patients (70%) from the standard care group (RR, 1.37; 95% CI, 1.14-1.62; P = .002). Other parameters were comparable across the 3 study groups.

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Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain

McNicol

Ferguson

Haroutounian

et al. 2016

Cochrane Database of Systematic Reviews

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Since the last version of this review, we have found 39 new studies providing additional information. Most included studies evaluated adults only. We reanalyzed the data but the results did not substantially alter any of our previously published conclusions. This review provides high quality evidence that a single dose of either IV paracetamol or IV propacetamol provides around four hours of effective analgesia for about 36% of patients with acute postoperative pain. Low to very low quality evidence demonstrates that both formulations are associated with few adverse events, although patients receiving IV propacetamol have a higher incidence of pain on infusion than both placebo and IV paracetamol.

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Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine

Abstract: Diclofenac after cesarean delivery improves analgesia and has a highly significant morphine-sparing effect. We were unable to demonstrate significant morphine-sparing effect of propacetamol or additive effect of propacetamol and diclofenac in this group of patients.

Cited by 64 publications

References 33 publications

Combined analgesics for postoperative pain therapy

Combined analgesics for postoperative pain therapy

Effectiveness of Acupuncture for Pain Control After Cesarean Delivery

Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain

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