Study of Preemptive Ana L Gesic Effects of Intravenous Paracetamol in Reducing Doses of Morphine in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

ABSTRACT:Paracetamol is primarily thought to be a cyclo-oxygenase inhibitor acting through central nervous system. Indirect effects of paracetamol are through serotonergic system as a nonopioid analgesic. We studied intravenous paracetamol 1 gram preoperatively to assess its intraoperative and post-operative analgesic effects, in reducing intraoperative morphine requirements, to reduce the requirement of postoperative analgesia, enable early recovery from anaesthesia and to reduce postoperative nausea and vomiting. One hundred patients from either sex classified in ASA Class I and II scheduled for laparoscopic cholecystectomy were randomly allocated into two groups of 50 patients each. Group I (Study group) received paracetamol 1 gram infusion prior to induction with 50µg/kg morphine diluted with normal saline to a total volume of 5ml. Group II (Control group) received l00µg/kg morphine diluted with normal saline to a total volume of 10ml at induction. We observed that there was significant increase in mean time for rescue analgesia from induction of anaesthesia in Group I (study group) was 11.25±1.827 hours and Group II (Control group) was 6.98±4.568 hours (p value < 0.001). The median value of visual analogue score was lower at all-time points in group I when compared to group II at each interval and it was statistically significant (p value < 0.001). A significant decrease in mean number of administered doses of rescue analgesia during 24 hours was seen in the study group (0.52±0.505) as compared to the control group (1.3±0.463) with a p value of < 0.001. Mean modified Aldrete score in the study group was 9.78±0.465 and in control group it was 8.1±1.15. It was statistically significant p value of <0.001. The mean number episodes of nausea and vomiting in group I were 0.74±0.633 and in group II 0.94±0.652 and was statistically insignificant with p value of 0.361. CONCLUSION: Administration of intravenous paracetamol and 50% doses of morphine prior to induction in patients undergoing laparoscopic cholecystectomy ensures effective analgesic intra-operatively as well as postoperatively and was associated with earlier discharge from post anaesthetic care unit when compared with full doses of IV morphine, however above combination was not able to decrease significantly reduction in morphine related adverse effects in these patients.