Morphine-sparing effect of intravenous paracetamol for post operative pain management following gynaecological surgery

Abstract

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) < or = 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.