Effect of a Paracetamol Intravenous Form Versus a Placebo on Morphine Consumption in Patients Undergoing an Open Appendectomy: A Randomized Double-lind Controlled Trial
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Multimodal analgesia in open appendicectomy patients helps reduce the side effects of each pain medication. Well-prepared pain management would help the patients have a shorter recovery period. A patient with non oral medical instruction would have a limited choice of pain medications. Thus, intravenous paracetamol would be one of the options that could be used in this group of patients.
OBJECTIVES: To compare the amount of cumulative morphine consumption in open appendicectomy patients who were treated with and without intravenous paracetamol.
METHODS: The prospective randomized double-blind controlled trial was conducted in 88 open appendicectomy patients at Burapha University Hospital, Chon Buri province, Thailand. The patients were divided into two equal groups. Spinal anesthesia was performed in all patients. After the surgery, the paracetamol group (group P) was given intravenous paracetamol every six hours with four doses in total. The control group (group C) was given a placebo every six hours with a total of four doses. The numeric rating scale (NSR) pain score, the amount of morphine consumption, and side effects of both the morphine and paracetamol were recorded at 0, 4, 8, 12, 24 and 48 hours after surgery.
RESULTS: The morphine consumption in the group that received intravenous paracetamol was significantly less than the group C at 4, 8, 12, 24, and 48 hours after surgery (p<0.001), and when comparing the NRS, they were statistically different at 8, 12, and 24 hours after surgery. (p=0.02, <0.001, <0.001 respectively)
CONCLUSIONS: The use of intravenous paracetamol could significantly reduce both the post-operative morphine consumption and numeric rating scale in open appendectomy patients.
Thaiclinicaltrials.org number, TCTR20220615003
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr 2012;31:783-800.
Furyk J, Levas D, Close B, Laspina K, Fitzpatrick M, Robinson K, et al. Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial. Emerg Med J 2018;35(3):179-84.
Kittikornchaichan K. Acute pain management with intravenous paracetamol. Thai J Anesthesiol 2019;45:117-23.
Liang L, Cai Y, Li A, Ma C. The efficiency of intravenous acetaminophen for pain control following total knee and hip arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2017 [cited 2021 Dec 25]; 96:e8586. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704817/pdf/medi-96-e8586.pdf
Shi SB, Wang XB, Song JM, Guo SF, Chen ZX, Wang Y. Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2018;13:250.
Jelacic S, Bollag L, Bowdle A, Rivat C, Cain KC, Richebe P. Intravenous acetaminophen as an adjunct analgesic in cardiac surgery reduces opioid consumption but not opioid-related adverse effects: a randomized controlled trial. J Cardiothorac Vasc Anesth 2016;30:997-1004.
Thienthong S, Niruthisard S, Ittichaikulthon W, Tontisirin N, Tungwiwat S, Nimmaanrat S, et al. Clinical guidance for acute postoperative pain management 2019 The Royal College of Anesthesiologists of Thailand (RCAT) and The Thai Association for the Study of Pain (TASP) : Second Edition.Thai J Anesthesiol2020;46:47-80.
Niraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, et al. Analgesic efficacy of ultrasound-guided transversusabdominis plane block in patients undergoing open appendicectomy. Br J Anaesth2009;103:601-5.
Huang PS, Gleason SM, Shah JA, Buros AF, Hoffman DA. Efficacy of intravenous acetaminophen for postoperative analgesia in primary total knee arthroplasty. J Arthroplasty2018;33:1052-6.
Sivakumar W, Jensen M, Martinez J, Tanana M, Duncan N, Hoesch R, et al. Intravenous acetaminophen for postoperative supratentorial craniotomy pain: a prospective, randomized, double-blinded, placebo-controlled trial. J Neurosurg2018;130:766-22.
Wong I, St John-Green C, Walker SM.Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. PaediatrAnaesth2013;23:475-95.
Kraglund F. Acetaminophen plus a nonsteroidal anti-inflammatory drug decreases acute postoperative pain more than either drug alone. J Am Dent Assoc.2014;145(9):966-8.