Effect of Intravenous Acetaminophen (Paracetamol) on Hemodynamic Parameters Following Endotracheal Tube Intubation and Postoperative Pain in Caesarian Section Surgeries

Abstract

Background:Use of analgesics, especially opioids, before delivery during cesarean section for preventing hemodynamic changes after endotracheal intubation and postoperative analgesia is limited due to their adverse effects on the neonate.Objectives:The aim of this study was to investigate the effect of intravenous acetaminophen (paracetamol) in blunting hemodynamic responses to endotracheal intubation and postoperative pain in parturient undergoing cesarean section by general anesthesia.Patients and Methods:Eighty parturients undergoing cesarean section by general anesthesia were randomly divided to receive either 15 mg/kg intravenous paracetamol (n = 40) or normal saline (n = 40) fifteen minutes before endotracheal intubation. Mean arterial blood pressure (MAP) and pulse rates were compared at baseline and after intubation at one minute interval for five minutes between the two groups. The patients were also compared for postoperative pain intensity and analgesic requirement.Results:Patients in the saline group experienced more pain in the recovery room (VAS 7.0 ± 1.24 vs. 6.15 ± 2.27; P value = 0.041) and required more fentanyl intraoperatively (150 µg vs. 87.7 ± 75; P value < 0.01) and meperidine postoperatively (12.88 ± 20.84 mg vs. 1.35 ± 5.73; P value = 0.002) than the paracetamol group. Mean arterial pressure (MAP) changes were similar after intubation in the both groups (P value = 0.71), however, pulse rates showed greater changes following intubation in the saline group (P value = 0.01).Conclusions:Intravenous acetaminophen administered before caesarean section reduced tachycardia after intubation, narcotic drugs administration during and after the operation and reduced pain in PACU.

Comparison of acetaminophen and nalbuphine in attenuating hemodynamic response to tracheal intubation.

“…A placebo controlled trial conducted by Soltani G et al on these patients showed that acetaminophen reduced tachycardia in response to endotracheal intubation when used before induction but has no effect on rise in blood pressure. 10 Our trial partially agrees with this study as it shows no significant blunting in rise of heart rate as well as blood pressure.…”

“…7,8 Studies conducted in the past to assess the efficacy of acetaminophen in attenuating the DOI: 10.29309/TPMJ/2020.27. 2.3921 hemodynamic presser response 9,10 found it to be efficacious. Acetaminophen has also been compared with local anesthetic agents like lidocaine.…”

Efficacy of Intravenous Infusion of Acetaminophen for Intrapartum Analgesia

“…Though its role in pre-emptive approach to management of postoperative pain has been adequately studied by various authors [12][13][14], there is paucity of work on utilization of paracetamol as an intrapartum analgesic drug. Thus, it appeared apposite to design a randomized trial to investigate the proposed use of acetaminophen.…”

I.V. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study

“…paracetamol during intrapartum period. [9][10][11][12][13][14][15][16][17][18] Elbohoty and colleagues 9 showed that use of i.v. paracetamol, was as effective as pethidine for intrapartum analgesia during the first stage of labour.…”

“…morphine, 14,15 or with saline during Caesarean section under general anaesthesia. [16][17][18] To the best of our knowledge, no study has compared the role of i.v. paracetamol as an adjunct analgesic agent, to the well established labour analgesia regimes.…”