Intravenous Paracetamol Improves the Quality of Postoperative Analgesia but Does not Decrease Narcotic Requirements

Abstract

Paracetamol, a centrally acting inhibitor of cyclooxygenase, has less gastrointestinal and platelet-inhibiting side effects and is clinically better tolerated than nonsteroidal anti-inflammatory drugs. Therefore, it will be ideally suited for postoperative pain relief. In this prospective, double-blind, randomized, placebo-controlled study, we evaluated the analgesic efficacy, opioid-sparing effect and effects on opioid-related adverse effects of intravenous (IV) paracetamol in combination with IV morphine after lumbar laminectomy and discectomy. Forty patients were divided into 2 groups (n=20 each) to receive either paracetamol 1 g (group 1) or 0.9% NaCl 100 ml (group 2) at the end of the operation and at 6-hour intervals over 24 hours. IV patient-controlled analgesia with morphine was used as a rescue analgesic in both groups. Pain was evaluated at rest and on movement at the 1st, 2nd, 4th, 6th, 12th, 18th, and 24th hours using a visual analog scale. Hemodynamic parameters, morphine usage, patient satisfaction, and probable side effects were also evaluated. Pain scores at rest and on movement at the 12th, 18th, and 24th hours were significantly lower in group 1 (P<0.001). Morphine consumption was not statistically significantly different between the groups (P>0.05). Vomiting in group 2 was significantly higher (P=0.027). Significantly more patients in the paracetamol group rated their pain management as excellent (45% vs. 5%). Although repeated IV paracetamol usage after lumbar laminectomy and discectomy did not demonstrate a significant opioid-sparing effect, it did decrease visual analog scale scores at certain evaluation times and incidence of vomiting and increase patient satisfaction.

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

“…Our results are in concordance with the studies by Yilmaz et al and Cakan et al, although they combined paracetamol with tramadol and morphine 24,29 . Despite the more eff ective control of postoperative pain by opioid analgesics, paracetamol alone may be considered as an effi cacious analgesic for postoperative pain relief following lumbar disc surgery.…”

“…Adequate pain management in this period has been observed to correlate well with improved functional outcome, early discharge, better ambulation, and preventing development of chronic pain syndrome 2 . Although opioid analgesics are the most widely used drugs for controlling postoperative pain, some authors have emphasized the use of intravenous paracetamol to improve postoperative pain and increase patient satisfaction following this type of surgery [29][30][31][32] . Th e effi cacy of paracetamol alone in the treatment of mild-to-moderate postoperative pain and its place in combination treatment were investigated [33][34][35] .…”

“…Cakan et al studied the effi cacy of paracetamol following lumbar disc surgery and concluded that paracetamol decreased visual analog scale (VAS) scores but did not decrease morphine consumption 29 . Th e hypothesis in our study was that intravenous paracetamol, administered through intermittent use or PCA pump, could relieve postoperative pain in patients undergoing lumbar discectomy.…”

The Effectiveness of Preemptive Analgesic Techniques on Postoperative Analgesia In Patients Undergoing Open Septorhinoplasty

“…[14] Çakan ve ark. bizim de çalışmamızda elde ettiğimiz gibi, lomber diskektomi olgularında parasetamolün hasta memnuniyetini artırdığı ancak opioid tüketi-mine etkisi olmadığı tespit etmiştir, [15] ancak çalış-mamızda elde ettiğimiz sonuçtan farklı olarak parasetamolün uygulandığı değişik cerrahi vakalarında opioid azaltıcı etkisi olduğu ve hastanın toplam opioid gereksinimini %24-46 oranında azalttığını ve bunun da analjezik tedavide toplam hasta memnuniyetinin artmasını sağladığı literatürlerde gösterilmiştir. [16] Çalışmamızda VAS değerleri parasetamol grubunda kontrol grubuna göre daha düşük olup toplam tramadol tüketimi arasında fark yoktur.…”

Acetaminophen Modulates P-Glycoprotein Functional Expression at the Blood-Brain Barrier by a Constitutive Androstane Receptor–Dependent Mechanism

“…However, a recent mixed treatment comparison analysis of 60 relevant clinical studies reported that APAP reduced the amount of morphine required by patients to manage pain in the first 24 hours following major surgery (Maund et al, 2011). This morphinesparing effect was only studied acutely and is not found in all patient populations (i.e., young infants) or following all procedures (i.e., lumbar laminectomy and discectomy, cesarean delivery) (Siddik et al, 2001;van der Marel et al, 2007;Cakan et al, 2008). Taken together, the results of these studies may reflect, in part, altered CNS delivery of morphine as a result of prior or concurrent APAP exposure over time.…”