Resumo
Objective: The study evaluated the morphine sparing effect of intravenous Paracetamol and the incidence of side effects in the recovery room following lower abdominal gynaecological surgery.
Method Fifty six, ASA I and II patients undergoing lower abdominal gynaecological surgery were randomized into two groups, which were either given (A) intravenous (I.V) Paracetamol 1g diluted to 20 mls with normal saline or (B) I.V normal saline 20 mls at the beginning of the skin closure. In the re covery room pain intensity was evaluated and the time of first request for analgesic was noted. Intravenous morphine 2mg bolus was titrated to . Pain relief was evaluated at rest and on movement until pain score at rest Numerical rating score (NRS) < was achieved. Total dose of morphine was noted, morphine side effects, adequacy of analgesia and patient’s satisfaction were assessed.
Results: The mean time of first analgesic request was prolonged significantly in Group A 40.9 ±18.9 minutes vs. 11.4 ± 5.5 minutes in Group B ( P = 0.00), with significant difference in morphine consumption 7.1 ±1.6 vs. 12.2 ± 2.1 (P = 0.01) respectively. Morphine related side effects were higher in placebo group (33.3%) compared with (11.1%) in paracetamol group. More patients in the paracetamol group compared with the placebo group felt pain relief was adequate (66.7% vs 44.4%) and also more patients were satisfied with the regimen in paracetamol group compared with placebo group (96% vs 29.6%).
Conclusion: Intravenous Paracetamol improved analgesia and reduced the amount of morphine consumption in the immediate postoperative period with reduced opioid side effects and better patient satisfaction.
Keywords: Opioid, morphine, paracetamol, multimodal analgesia, postoperative pain
Résumé
Objectif: L’étude a examiné l’effet de la morphine de paracétamol par voie intraveineuse et les cas d’effets indésirables dans la salle de convalescence après la chirurgie gynécologique de l’abdomen inférieur.
Patients et méthode: Cinquante-six malades de ASA I et II subissant une chirurgie gynécologique de l’abdomen inférieur ont été au hasard séparés en deux groupes. On leur a donné (A) par voie intraveineuse du (I.V) paracétamol 1g dissout dans 20 ml avec une solution saline normale ou (B) I.V saline normale 20 ml au début de la cicatrisation. Au cours de la convalescence, l’intensité de la douleur a été évaluée et le temps de la première demande analgésique a été noté. 2 mg de morphine en bols a été donnée par voie intraveineuse. Le soulagement de la douleur a été évalué au repos et en mouvement jusqu’à ce que la valeur de la douleur au repos (ORA < 4) soit atteint. La dose totale de morphine a été notée, Les effets secondaires de morphine, de l’adéquation de l’analgésie et la satisfaction des patients ont été évalués.
Résultats: Le temps moyen de la première demande analgésique a été prolongée de façon significative dans le groupe A 40,9 ± 18,9 minutes contre 11,4 ± 5,5 minutes dans le groupe B (p = 0,00), avec une différence significative dans la consommation de morphine 7,1 ± 1,6 contre 12,2 ± 2,1 (p= 0,01), respectivement Les effets secondaires liés à la morphine étaient plus élevés dans le groupe placebo (33,3%), comparativement à (11,1%) dans le groupe paracétamol. Plus de patients dans le groupe paracétamol ont senti une douleur adéquate contrairement au groupe placebo (66,7% contre 44,4%) aussi les patients dans le groupe paracétamol ont été plus satisfaits dans les soins (traitement) que ceux du groupe placebo (96% contre 29,6%).
Conclusion: Le paracétamol par voie intraveineuse augmente l’analgésie et réduit la quantité de la consommation de morphine au cours de la période qui suit immédiatement l’opération en réduisant les effets indésirables des opiacés avec la bonne satisfaction des patients.
Correspondence: Dr. R.P. Olonisakin, Department of Anaesthesia, University College Hospital, Ibadan, Nigeria. E-mail: bolasakin@yahoo.com; polonisakin@gmail.com.
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