Postoperative analgesia withiv propacetamol and ketoprofen combination after disc surgery

Abstract

Postoperative analgesia with iv propacetamol and ketoprofen combination after disc surgery Purpose: The concept of balanced analgesia suggests that a combination of analgesic drugs may enhance analgesia and reduce side effects after surgery. This study evaluated the effect of the combination of propacetamol (Prodafalgan) and ketoprofen (Profenid) after surgery of a herniated disc of the lumbar spine. Methods: After randomization, 60 patients received: placebo (group I); 2 g propacetamol (group 2); 50 mg ketoprofen (group 3); or a combination of 2 g propacetamol and 50 mg ketoprofen (group 4). Drugs were administered every six hours for two days after surgery. The patients used morphine with patient controlled analgesia pumps (bolus I rag; lock out time I 0 rain) and were evaluated with a visual analogue scale (VAS) at rest and movement every six hours for two days. Side effects were noted. Results: The patient characteristics and surgery were identical for each of the four groups. The VAS scores throughout the study were lower in group 4 than in groups I, 2 and 3 both at rest (P < 0.05) and on movement (P < 0.0 I). The cumulative dose of morphine at 48 hr was lower in group 4 than in group I (23.4 ___ 5 mg vs 58.9 -+ 9 mg; P < 0.01) or group 2 (23.4 +_ 5 mg vs 43.4 __+ 6.6 rag; P < 0.05) and similar to that in group 3 (34.2 _+ 4.5 mg). The incidence of side effects was similar in all groups. Condu, ion: The combination of propacetamol and ketoprofen recluced pain scores both at rest and on movement. The drug combination did not reduce the morphine consumption and incidence of side effects.

Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

“…Although other investigators have proposed pain as a cause for postoperative hypertension associated with increased circulating catecholamines, our results show that the combination of propacetamol and ketoprofen was effective for pre-and postoperative analgesia, reducing peripheral nociception and hence reducing the pain and inflammatory response to surgical trauma (20,21). In addition, because this analgesic combination does not cause adverse effects such as those produced by opioids (respiratory depression, sedation, urinary retention, nausea and vomiting) it did not contribute to the repetitive surgically induced disordered breathing (20).…”

“…Additionally, preoperative anxiety and fear and postoperative pain can induce a psychological stress that in turn can alter the homeostasis of BP, heart rate (HR) and neural activity (17)(18)(19). Severe pain has been frequently reported after upper airway surgery for OSAS, leading to the use of newer approaches for postoperative analgesia, such as the combination of a nonopioid analgesic with nonsteroidal anti-inflammatory drugs (20,21), but their efficacy after upper airway surgery has not been evaluated.…”

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

“…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] .…”

Combined analgesics for postoperative pain therapy

“…Von den 25 analysierten Arbeiten verglichen insgesamt 23 Studien Paracetamol in unterschiedlichen Applikationsformen oder dessen "pro-drug" Propacetamol, das nach i.v.-Gabe zu 50% zu seiner aktiven Form Paracetamol metabolisiert wird, mit verschiedenen Nichtopioidanalgetika: Acht Studien mit Diclofenac [3,6,14,15,19,23,25,26], vier Studien mit Ketoprofen [1,2,12,14], zwei Studien mit Ibuprofen [8,44], eine mit Ibuprofen und dem COX-2-Hemmer Rofecoxib [30], drei weitere nur mit den COX-2-Hemmern Rofecoxib und Celecoxib [17,18,27], eine mit Suprofen [11], eine mit und ohne Ketorolac vs. Morphin [22], eine mit Fenoprofen [10], eine mit Tenoxicam [43] und eine mit ASS mit und ohne Koffein [32]. Je eine weitere Studie untersuchte ASS zusammen mit Mefenaminsäure [29] sowie Diclofenac mit Azapropazon [38].…”

“…In allen diesen Untersuchungen wurden die Testsubstanzen an mehreren Zeitpunkten appliziert [1,2,12,14]. In zwei Studien wurde die Kombination mit Propacetamol allein [1,2] und in zwei Studien mit beiden Einzelpräparaten [12,14] untersucht. Eine Studie beinhaltete auch eine Placebogruppe [9].…”