Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

884 Improving the Analgesia Prescribing Compliance to NICE Guidelines (NG118) In Suspected Renal Colic Patients Using a Proforma

Aim To improve analgesia prescribing for patients admitted with suspected renal colic in line with NICE guidelines (NG118) in an acute district general hospital using a proforma. Method In the first cycle, a retrospective review of 16 patients who presented with renal colic to the emergency department or surgical assessment unit was performed and the analgesia prescribing was recorded. A unique analgesia prescribing proforma was then developed using NICE guidelines (NG118) including the use of NSAIDS as first-line when there are no contra-indications, intravenous paracetamol, opioid analgesics and omitting antispasmodics. Following implementation of the proforma, a prospective review of 18 patients were included in the second cycle and the prescribing compliance were compared. Results Study included 34 patients who presented with suspected renal colic over a 3-month period. In the first cycle, 19% of patients had appropriate analgesia prescribed which were compliant with NICE guidelines. In cycle 2, 89% of patients had appropriate analgesia prescribed. In particular, the inappropriate prescription of antispasmodics has improved significantly (38 % in cycle 1 vs 0 % in cycle 2). Conclusions A proforma can serve as a useful ‘checklist’ for analgesia prescribing and improve the symptomatic relief for patients presenting with suspected renal colic in line with NICE quality standards.

Comparison of Intravenous Paracetamol Prophylaxis versus Placebo for Prevention of Pain with Injection Rocuronium

Aim: To compare the frequency of absence of pain with injection paracetamol versus placebo given before injection rocuronium in patients undergoing elective procedures Study design: Randomized Controlled Trial Place and duration of study: Dept of Anaesthesia, Civil Hospital, Karachi from 15th January to 14th July 2017. Methodology: One hundred and two patients aged 25-75 years of either gender undergoing elective surgery were enrolled. The lottery method was used to divide the patients into two equal groups. Paracetamol (5 mL, 10 mg/mL) or normal saline (5 mL) were used as pretreatment solutions. When the tourniquet was removed after 2 minutes, the rocuronium at 1% concentration was injected throughout the 10 second’s period. Patients were then advised and asked to rate their pain on the hand's dorsum using VAS. Results: Mean age of the patients was 44.11±7.75 years. Mean pain score was 1.49±1.38. Significant difference was observed in the mean pain score in between paracetamol and placebo group (p-value <0.001). Overall absence of pain was found in 49 (40.8%). Absence of pain was found to be higher 34 (69.4%) in paracetamol group as compared to placebo group (p-value <0.001). Conclusion: Frequency of absence of pain found lower in patients undergoing elective procedures with injection paracetamol versus placebo given before injection rocuronium. Keywords: Injection rocuronium, Elective procedures, Injection paracetamol, Absence of pain

PRE-EMPTIVE EFFECT OF INTRAVENOUS PARACETAMOL VERSUS INTRAVENOUS KETOROLAC ON POST-OPERATIVE PAIN AND SHIVERING AFTER SEPTOPLASTY UNDER GENERAL ANESTHESIA: A COMPARATIVE STUDY

Objective: To observe the pre-emptive effect of intravenous paracetamol versus intravenous ketorolac in preventing postoperative shivering and pain after septoplasty in postoperative care unit. Study Design: Prospective comparative study. Place and Duration of Study: Main Operation Theatre of Frontier Corps Hospital Quetta, from Sep to Dec 2019. Methodology: After ethical committee approval, 90 American Society of Anaesthesiologist (ASA-I patients, aged between 18-45 years, scheduled for septoplasty, were recruited and divided into three equal groups, Paracetamol (PA), Ketorolac (KE) and Placebo (PL) as per computer generated table. The paracetamol (PA) group (n=30) received 1gm intravenous paracetamol, ketorolac (KE) group (n=30) received 30mg intravenous ketorolac and group placebo (PL) received 100ml normal saline, 20 minutes before completion of surgery. Postoperative shivering and pain was assessed via four-point scale and visual analogue scale (VAS) respectively, in post-anesthesia care unit at 10 and 30 minutes post-extubation. Results: Mean visual analog scale (VAS) score in paracetamol group was 2.7 ± 1.41, ketorolac group was 2.3 ± 1.24 and in placebo group was 3.6 ± 1.44, with a p-value of 0.002. Mean four point shivering score in paracetamol group was 0.3 ± 0.55, ketorolac was 0.7 ± 0.78 and placebo group was 1.4 ± 1.00, with a p-value of <0.001. Conclusion: The effect of paracetamol is better than ketorolac in preventing pain and shivering after septoplasty under general anesthesia.

The hemodynamic effects of intravenous paracetamol (acetaminophen) in patients with chronic liver disease undergoing liver transplantation: a pilot study

Objective We performed a single-center double-blinded, randomized trial to investigate the hemodynamic effects of IV paracetamol in patients with chronic liver disease (CLD) undergoing liver transplantation surgery. Patients with CLD are particularly susceptible to hemodynamic derangements given their low systemic vascular resistance state. Accordingly, hypotension is common in this setting. The hemodynamic effects of IV paracetamol in patients undergoing elective liver transplantation are unknown, therefore we evaluated whether the intraoperative administration of IV paracetamol in patients with chronic liver disease undergoing liver transplantation results in adverse hemodynamic effects. The primary end point was a change in systolic blood pressure 30-min after the preoperative infusion. Results Twenty-four participants undergoing liver transplantation surgery were randomly assigned to receive a single bolus of IV paracetamol (1 g paracetamol + 3.91 g mannitol per 100 mL) (n = 12) or placebo (0.9% Saline 100 mL) (n = 12). All participants completed their study intervention, and there were no breaches or violations of the trial protocol. Baseline characteristics were similar in both groups. There were no significant differences regarding surgical duration, intraoperative use of fluids, and intraoperative noradrenaline use. After the administration of paracetamol there were no significant differences observed in blood pressure or other hemodynamic parameters when compared to placebo.

Paracetamol: A Review of Guideline Recommendations

Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.