Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial

Özmete, Özlem; Bali, Çağla; Çok, Oya Yalçın; Ergenoğlu, Pınar; Özyılkan, Nesrin Bozdoğan; Akın, Şule; Kalaycı, Hakan; Aribogan, Anıs

doi:10.1016/j.jclinane.2016.02.030

Cited by 35 publications

(10 citation statements)

References 18 publications

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“…Importantly, the use of preoperative IV paracetamol was not associated with an increased incidence of patient side effects [12,13] or adverse effects on the newborn. Administration of preoperative IV paracetamol did not result in elevated neonate cord blood levels [16] and there were no significant differences in mean 1 min and 5 min Apgar scores [11,13].…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, there are emerging concerns regarding prenatal paracetamol exposure and its potential effect on child neurodevelopment [23]. Although administration of preoperative IV paracetamol did not result in elevated neonate cord blood levels [16] and there were no significant differences in mean 1 min and 5 min Apgar scores [11,13], its long term effects on child neurodevelopment remain unknown.…”

Section: Discussionmentioning

confidence: 99%

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A Meta-Analysis of the Utility of Preoperative Intravenous Paracetamol for Post-Caesarean Analgesia

Loke

Yeo

et al. 2019

Medicina

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Background and objectives: Worldwide, the number of caesarean sections performed has increased exponentially. Some studies have reported better pain control and lower postoperative requirements for opioids when intravenous (IV) paracetamol was administered preoperatively. This meta-analysis thus aimed to investigate the utility of preoperative IV paracetamol for post-caesarean analgesia. Materials and Methods: By using the keywords (paracetamol OR acetaminophen) AND [cesarea* OR caesarea* OR cesaria* OR caesaria*], a systematic literature search was conducted using PubMed, Medline, Embase, Google Scholar and ClinicalTrials.gov databases for papers published in English between January 1, 1960 and March 1, 2019. Grey literature was searched as well. Results: Seven clinical trials were reviewed, while five randomized, placebo-controlled, double-blind studies were included in the final meta-analysis. Applying per-protocol analysis and a random-effects model, there was a significant reduction in postoperative opioid consumption and pain score in the group that received preoperative IV paracetamol, compared to placebo, as the standardized mean difference (SMD) were −0.460 (95% CI −0.828 to −0.092, p = 0.014) and −0.719 (95% CI: −1.31 to −0.13, p = 0.018), respectively. However, there was significant heterogeneity amongst the different studies included in the meta-analysis (I2 = 70.66%), perhaps owing to their diverse protocols. Some studies administered IV paracetamol 15 min before induction while others gave it before surgical incision. Conclusion: This is the first review on the topic. Overall, preoperative IV paracetamol has convincingly demonstrated useful opioid-sparing effects and it also appears safe for use at the time of delivery. It should be considered as a component of an effective multimodal analgesic regimen. Future studies could be conducted on other patient groups, e.g., those with multiple comorbidities or chronic pain disorders, and further delineate the optimal timing to administer the drug preoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Utility of Preoperative Intravenous Paracetamol for Post-Caesarean Analgesia

Loke

Yeo

et al. 2019

Medicina

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“…Our results are clinically important since liposome bupivacaine can be mistakenly trusted by clinical practitioners to reduce late postoperative pain (≥24 hours). This may result in reduced use of more conventional multimodal analgesics with established efficacy in decreasing postoperative pain (e.g., nonsteroidal anti-inflammatory drugs, and acetaminophen) [ 39 – 42 ]. Moreover, the use of liposome bupivacaine may reduce the use of nerve or field blocks with established efficacy in improving postoperative analgesia [ 43 – 46 ].…”

Section: Discussionmentioning

confidence: 99%

Liposome Bupivacaine Compared to Plain Local Anesthetics to Reduce Postsurgical Pain: An Updated Meta-Analysis of Randomized Controlled Trials

Kendall

Alves

Oliveira

2018

Pain Research and Treatment

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Objective Peripheral nerve blocks for postoperative analgesia have improved block success, but analgesia efficacy has been limited by the short duration of traditional local anesthetics. The results of randomized trials comparing liposome bupivacaine with conventional local anesthetic formulations (e.g., plain bupivacaine and ropivacaine) have generated conflicting results. This study was conducted to systematically review the effectiveness of analgesic efficacy of liposome bupivacaine infiltration at the surgical site versus plain local anesthetic bupivacaine or ropivacaine in patients undergoing surgery. Methods PRISMA statement guidelines were followed. A search of electronic databases National Library of Medicine's PubMed database, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from January 2012 to September 2017 was performed. Among the 1,612 records identified, 9 randomized controlled trials involving 779 patients were eligible for data extraction and meta-analysis. Results Liposome bupivacaine did not reduce postsurgical pain at rest compared to plain local anesthetics at 24 and 48 hours after surgery. Moreover, liposome bupivacaine did not reduce postoperative opioid consumption at 24, 48, or 72 hours when compared to plain local anesthetics. Liposome bupivacaine did reduce postoperative nausea when compared to plain local anesthetics (P =<0.3). There was no significant difference in hospital length of stay between study groups, the use of plain bupivacaine or ropivacaine, or among orthopedic or nonorthopedic procedures. No manifestations of local anesthetic toxicity were reported. Conclusions Our results suggest that liposome bupivacaine does not have an analgesic advantage when compared to plain local anesthetics at the surgical site for patients undergoing surgical procedures.

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“…More elapsing time was likely needed to achieve the peak effect of the drug and this probably explains the late but not early analgesic effect of the drug in the current study. For short surgical procedures—such as outpatient breast surgery—earlier administration of the drug (ie surgical start) may be a more effective strategy to obtain better analgesic outcomes in the immediate postsurgical period . Nonetheless, one could argue that the postdischarge period should be prioritized in ambulatory surgery, as patients are required to treat their pain with less potent oral analgesics …”

Section: Discussionmentioning

confidence: 99%

“…For short surgical procedures-such as outpatient breast surgery-earlier administration of the drug (ie surgical start) may be a more effective strategy to obtain better analgesic outcomes in the immediate postsurgical period. 21,22 Nonetheless, one could argue that the postdischarge period should be prioritized in ambulatory surgery, as patients are required to treat their pain with less potent oral analgesics. 23,24 Few studies have specifically tested the efficacy of interventions to improve patient reported quality of recovery after ambulatory surgery.…”

Section: Discussionmentioning

confidence: 99%

Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial

et al. 2017

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Few systemic drug interventions are efficacious to improve patient reported quality of recovery after ambulatory surgery. We aimed to evaluate whether a single dose systemic acetaminophen improve quality of recovery in female patients undergoing ambulatory breast surgery. We hypothesized that patients receiving a single dose systemic acetaminophen at the end of the surgical procedure would have a better global quality of postsurgical recovery compared to the ones receiving saline. The study was a prospective randomized double blinded, placebo controlled, clinical trial. Healthy female subjects were randomized to receive 1 g single dose systemic acetaminophen at the end of the surgery or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman rho. P < .05 was used to reject the null hypothesis for the primary outcome. Seventy subjects were randomized and sixty-five completed the study. Patients' baseline characteristics and surgical factors were similar between the study groups. There was a clinically significant difference in the global QoR-40 scores between the acetaminophen and the saline groups, median (IQR) of 189 (183 to 194) and 183 (175 to 190), respectively, P = .01. In addition, there was an inverse relationship (Spearman's rho= -0.33) between oral opioid consumption at home (oral morphine equivalents) and 24 hour postoperative quality of recovery, P = .007. A single dose of systemic acetaminophen improves patient reported quality of recovery after ambulatory breast surgery. The use of systemic acetaminophen is an efficacious strategy to improve patient perceived quality of postsurgical recovery and analgesic outcomes after hospital discharge for ambulatory breast surgery.

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Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial

Cited by 35 publications

References 18 publications

A Meta-Analysis of the Utility of Preoperative Intravenous Paracetamol for Post-Caesarean Analgesia

A Meta-Analysis of the Utility of Preoperative Intravenous Paracetamol for Post-Caesarean Analgesia

Liposome Bupivacaine Compared to Plain Local Anesthetics to Reduce Postsurgical Pain: An Updated Meta-Analysis of Randomized Controlled Trials

Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial

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