Intravenous acetaminophenvs oral ibuprofen in combination with morphine PCIA after Cesarean delivery

Abstract

Purpose:To compare the effects of iv acetaminophen with those of oral ibuprofen with respect to postoperative pain control and morphine requirements in patients receiving morphine patient-controlled iv analgesia (PCIA) after Cesarean delivery.Methods: Forty-five term patients scheduled for Cesarean delivery were randomized to receive acetaminophen 1 g iv every six hours plus oral placebo (group A) or ibuprofen 400 mg po every six hours plus iv placebo (group I); the first dose of study drug was given 30 min preoperatively. Postoperatively, all patients received PCIA for 48 hr using morphine bolus dose 2 mg iv, lockout interval ten minutes, and no basal infusion. Visual analogue scale (VAS; 0 to 10) at rest and morphine requirements were recorded every hour for four hours then every four hours for a total of 48 hr postoperatively. Patient satisfaction was recorded on a ten-point scale (from 1 to 10) 48 hr postoperatively.Results: Visual analogue scale scores decreased similarly in both groups over time, however, there were no differences between groups at any time during the study period (estimated marginal means: 1.4 ± SEM 0.2 vs 1.9 ± SEM 0.2 for groups A and I, respectively, P = 0.124). Cumulative doses of postoperative morphine were 98 ± 37 vs 93 ± 33 mg for groups A and I, respectively (P = 0.628). Patient satisfaction with analgesia was high in both groups (9 ± 1 vs 9 ± 1, P = 0.93). Conclusion:Intravenous acetaminophen is a reasonable alternative to oral ibuprofen as an adjunct to morphine patient-controlled analgesia after Cesarean delivery. Objectif

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

“…The NRS at rest and movement showed a rising trend and was found to be highest at 12 hours and then a declining trend was observed. Somewhat similar observations were made in the study of Alhashemi et al [12] where they found a peak of morphine requirement between 4 -8 hours. The gradual increase in NRS score and rescue analgesia during this time could be explained by the recession of spinal anaesthesia and patients' mobilization.…”

Intravenous Acetaminophen Versus Intravenous Morphine Sulfate for Isolated Diaphyseal Long Bone Fractures: A Randomized Clinical Trial

“…Results of the similar studies did not show any significant difference in the analgesic effect of intravenous acetaminophen and morphine (3)(4)(5)(6)(7)(8)(9).…”

“…A single-blind emergency department study over patients presenting with renal colic found that intravenous acetaminophen was equally effective as intravenous morphine (3). There are also some other studies showing that intravenous acetaminophen is as effective as intravenous morphine in pain management (4)(5)(6)(7)(8)(9).…”

Postpartum Hypertension

“…The effect of these factors has not been carefully studied in clinical trials; nevertheless, we suggest that a potential strategy for minimizing PP HTN would be to use alternative postpartum analgesia such as acetaminophen and narcotics. 19,20 Given the rare, but devastating potential consequences of PP HTN, we congratulate Goel et al for highlighting the high prevalence and the need for additional investigation regarding prevention, pathophysiology, and treatment.…”