[Role of paracetamol in a balanced postoperative analgesia scheme after thoracotomy]

Abstract

The efficiency of paracetamol used in the balanced multimodal analgesia after thoracotomy still remains unclear. The prospective study covered 75 adult patients operated on the chest. The patients were randomized to 3 groups. They all received epidural autoanalgesia with a mixture of fentanyl (2 microg/ml) in 0.2% ropivacaine solution and intramuscular injections of ketorolac, 30 mg, every 8 hours. In Group 1 (n = 25), paracetamol was intravenously injected in a dose of 4 g daily. In Group 2 (n = 23), rectal paracetamol was used in an equipotential dose. In Group 3 (n = 24), paracetamol was not given. Within the first 24 postoperative hours, the severity of the pain syndrome and the incidence of adverse reactions of analgesia were estimated in all the patients. The obtained data were compared using Student's t-test and x2 test, by taking into account Bonferroni's correction. The p values of < 0.0017 were determined as statistically significant. The resting VAS did not differ between the groups. In cough, the severity of the pain syndrome was significantly less in Group 1 than in Groups 2 and 3. The use of the epidural mixture of ropivacaine and fentanyl required for adequate analgesia within the first 24 hours after surgery was much less in Groups 1 and 2 than that in Group 3. The high incidence of skin itch (20%) and urinary retention (8%) was observed in Group 3 (p < 0.017). No difference was found between the groups in the development of dyspepsia. The use of paracetamol in the postoperative multimodal analgesic therapy program after thoracotomy reduces the daily dose of epidurally administered ropivacaine and fentanyl with evident upgrade of analgesia quality, and the incidence of opioid-induced adverse reactions.