International Journal of Current Research and Review
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IJCRR - 14(14), July, 2022

Pages: 22-26

Date of Publication: 20-Jul-2022


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Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study

Author: Humaira Tahir, Pari Gul Baloch, Mubushra Samina, Ifat Balouch, Sundas Ahmad, Zakia Bano

Category: Healthcare

Abstract:Introduction: Aim/Objective: To compare first analgesic demand in minutes after obstetrics & gynecological operative procedures between pre-emptive versus intra-operative groups by using intravenous paracetamol. Study Design: A cross-sectional study Place and Duration: Department of Obstetrics & Gynecology, Social Security Landhi Hospital, Karachi, and the total duration was 18 months i.e. 1st January 2019 till 30th June 2020. Methodology: Total number of patients were 120 and the age range was between 22- 50 years. Randomly patients were divided into two equal groups, group 1 and group 2. A total of 60 patients were in each group. In group 1, 1gram intravenous paracetamol was given 15 minutes before anesthesia either spinal or general. While in group 2, the same dose of intravenous paracetamol was given during operative procedures. Mean time for the first analgesic demand was observed and recorded. Result: Mean age of the patients was 40.53 \? 9.10 years in group 1 and 39.25 + 10.70 years in group 2 and the p-value was 0.820. The mean weight of patients was 62.25 \? 9.24 kg in group 1 and in group 2, it was 57.21 \? 11.48 kg and the p-value was 0.689. American society of anesthesiology-I status was found in 56 patients and American society of anesthesiology-II status was found in 64 patients. The mean time required for the first analgesic demand in group 1 was 188.75 \? 7.75 minutes and in group 2, it was 158.90 \? 12.50 minutes and the p-value was found < 0.001 (significant) Conclusion: Time required for the first analgesic demand is prolonged (188.75 \? 7.75 minutes) in the pre-emptive paracetamol group as compared with the intra-operative group (158.90 \? 12.50 minutes).

Keywords: American society of anesthesiology, First analgesic demand, Intra-operative paracetamol, Pre-emptive paracetamol, Standard monitoring, Intravenous paracetamol

Full Text:

Introduction

Post-operative pain is a common issue after major surgeries and its incidence is 80%, among this 39% of patients have faced extreme pain. Opioids are very effective for post-operative pain management but have some side effects like somnolence, hypotension, respiratory depression, and nausea and vomiting.1

Post-operative pain and its complications are a major concern to surgeons and as well for the anesthesiologist. For perioperative pain management, various methods are employed. Optimal pain management can reduce postoperative complications, enhances recovery, and reduces the length of stay in the hospital.2 Inappropriate post-operative pain management is associated with impaired wound healing, delayed gastrointestinal motility, and a higher risk of thromboembolism.3

Acetaminophen (paracetamol) is recommended for perioperative multimodal analgesic according to current guidelines. Acetaminophen is being used as an adjuvant analgesic and reduces opioid related-related side effects. Intravenous acetaminophen has been used for pain management due to its pharmacokinetic property and higher bioavailability.4 Production of mediators which are causing nerve stimulation is reduced by pre-emptive analgesia. Different methods are existing for pre-emptive analgesia i.e. epidural block, local anesthesia, nerve block, etc.5 Paracetamol acts on the central nervous system and belongs to a group of drugs which is called non-opioid.6 Pre-emptive analgesia should be given before starting surgical procedures to avoid the painful stimulus and to prevent post-operative pain as well as pre-emptive analgesia inhibit the central sensitization which is caused by incisional injuries.7

A society of anesthesiologists (ASA) recommended reducing or avoiding opioid drugs in intra-operative procedures and post-operative pain management.8 Still management of post-operative pain is challenging for clinicians, although very rousing techniques and drugs are accessible.9 Paracetamol with NSAIDs (a combination) for postoperative pain are being used for many years but remains controversial.10

Paracetamol is a safe analgesic drug among children for postoperative pain management.11 Intravenous paracetamol has been found to be more novel and has an antipyretic effect through the hypothalamus. It is very safe, cost-effective, easily available and beneficial for the management of pain12.  Although oral paracetamol is effective, and well-tolerated but patients require fast starting elimination of pain after surgery.  Parenteral paracetamol has additional fast onset of action and also has a lengthier duration than oral paracetamol.13

Methodology

This study was held after approval from ethical committee for research. A total of 120 patients were selected.  Non-probability sampling technique was used. Patients were included in the study according to ASA-I status (American society of anesthesiology) and ASA-II status. Age ranges from 22 -50 years.

Patients were excluded from the study who were not willing, were less than 22 years and more than 50 years, had known paracetamol hypersensitivity, chronic liver issues, renal diseases, and who had been taking different painkiller drugs for many years. Patients were registered for major surgeries of Obstetrics & Gynecology like Abdominal Hysterectomy, vaginal hysterectomy, ovarian masses, Ectopic pregnancies, and masses of the uterus. Patients were divided into two different groups, group-1, and group-2, and were equal in numbers. A total of 60 patients were enrolled for group 1, and sixty patients for group 2. In the pre-emptive paracetamol group, 1 gram paracetamol via intravenous was given 15 minutes prior to induction of anesthesia either spinal or general. In the intra-operative paracetamol (group 2) 1 gram I/V paracetamol was given during operative procedures. Standard monitoring was established in the operating room like an electrocardiogram, blood pressure, oxygen saturation by a pulse oximeter, and capnography were recorded. After performing surgeries, patients were shifted to the post-anesthesia care unit (post-anesthesia care unit) for further post-operative care. The mean time required for the first request for analgesic demand in minutes was recorded. On duty, resident doctors collected data. Variables used for data were the meantime for 1st request for analgesia, mean age of patients, ASA-I status, and ASA-II status. SPSS. 20 versions were used for data analysis. Chi-square test and t-test were applied for analysis.

Results

Total patients were 120 and among them 56 were ASA –I status and 64 were ASA-II. The mean time was 188.75 ± 7.75 minutes for first analgesic demand in group 1 and in group 2, it was 158.90 ± 12.50 minutes showing the better analgesic effect in the pre-emptive paracetamol group.

Figure 1: showing ASA Status in both groups. ASA-I patients were 34 (56.67%) in the pre-emptive paracetamol group and 22 (36.67 %) in the intraoperative paracetamol group. While 26 (43.33%) patients having ASA-II status in pre-emptive group and 38 (63.33%) patients in intra-operative group.

Table I: Represent the ages of the patients in both groups. Mean age was 40.53 + 9.10 years in the pre-emptive paracetamol group (group 1) and 39.25 ±10.70 years in intra-operative paracetamol group (group 2). p-value was insignificant i.e. 0.820 and (C.I.) Confidence Interval was -8.1 to 10.59.

Table II: Explain the mean time for first analgesic demand in the pre-emptive and intra-operative paracetamol groups. The mean time for first analgesic demand in group 1 was 188.75 + 7.75 minutes while in group 2, it was 158.90 ± 12.50 minutes. P-value was very significant i.e. 0.001 and (C.I.) confidence interval was 23.26 to 34.66.

Table III: Represent ASA-I Status and mean time required for first analgesic demand in both groups. Total patients were 56 and 34 patients were in pre-emptive group (group-1) and in 22 patients were in intra-operative group. The mean time for first analgesia was 189.75 ± 6.70 minutes in the pre-emptive paracetamol group and 159.91 ± 14.40 minutes in the intra-operative paracetamol group. P-value was less than 0.001 (significant) and confidence interval (C.I.) was between 19.63- 37.11.

Discussion

In a study, the mean time of first analgesic demand after surgery was significantly higher as compared with the control group i.e. 3.6 ± 3.6 versus 2.3 ± 3.1 correspondingly, and the p-value was significant i.e. 0.030.14 In another study intravenous paracetamol (preemptive) group required a long time in minutes for the first request for analgesic requirement and have minimum post-operative side effects. There were no significant differences noted in both groups regarding their age, weight, and ASA physical status, this is correlating with our study. 15

According to Arsalan M et al. Insignificant findings were noted between two groups regarding the demographic variable like age, weight, and as well as ASA physical status.The time required for the first request for analgesia was lengthier in the paracetamol (preemptive group) compared with the intraoperative paracetamol group and placebo group, this is also correlating with our study.13

A study demonstrated that in head and neck cancer surgeries pre-emptive intravenous paracetamol is very effective for post-operative pain management and due to its usage patient can discharge earlier from the hospital. Both groups were found to be similar regarding their age, weightand ASA physical status16

Data of both groups were similar in age, weight, BMI, and gender. The mean VAS pain score in the intravenous paracetamol group was found 6.3 ± 0.99 as compared with 6.20 ± 1.30 in the intravenous tramadol group, showing no significant difference between both groups.17

Patients had more pain in the recovery room (VAS score for pain 7.0 ±1.24 versus 6.15±2.27) in the saline group and the p-value was significant i.e.0.041 and needed further fentanyl intra-operatively (150 micrograms versus 87.7 ± 7.5) and p-value was less than 0.01 18

Patients had higher and more significant VAS pain scores in the pre-emptive group than patients in the intra-operative group (3.9 =+0.3, 3.3+ 0.4 versus 2.8+0.2 and 2.6+0.3) immediately and after 6 hours of surgery and p-value were <0.001 and < 0.01.19 this is not correlated with our study. In a study mean pain scores (VAS) were recorded at 15 minutes, 30 minutes, 1 hour, 2 hours, and 6 hours and they were found greater in the intra-operative group compared to a pre-emptive group, and the p-value <0.05. Time to first request for the analgesic drug was significantly lengthier in the pre-emptive group compared to the intra-operative paracetamol (group 1) and the p-value was <0.0329.20 this is correlating with our study. In the pre-emptive group, hydromorphone consumption was significantly lower as compared with the placebo group at all times and the p-value was 0.013. In the pre-emptive group, consumption of morphine drugs was also reduced up to 30%.21 Post-thoracotomy ipsilateral shoulder pain was decreased when paracetamol was given pre-emptively .22

Conclusion

The time required for the first analgesic demand was prolonged (188.75 ± 7.75 minutes) in the pre-emptive paracetamol group (group 1) as compared with the intra-operative paracetamol group (group 2) i.e. 158.90 ± 12.50 minutes.

Acknowledgement:

Funding

Funding source: Sindh Employee’s Social Security institution, ministry of labor Sindh

Permission

The ethical review committee gave the permission

Conflict of interest

None

Authors’ Contribution:

Dr Humaira Tahir: Concept, a study design. And supervised the study

Dr Pari Gul Baloch: Helped in article writing

Dr Mubushra Samina: Data Collection

Dr Ifat Balouch: Drafting

Dr Sundas Ahmad: Helped data analysis

Dr ZakiaBano: Final editing

References:

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7. Kharouba J, Hawash N, Peretz B, Blumer S, Srour Y, Nassar M, Sabbah M, Safadi A, Khorev A, SomriM. Effect of intravenous paracetamol as pre-emptive compared to preventive analgesia in a pediatric dental setting: a prospective randomized study. Int. J. of Paediatric Dentistry.2018; 28(1):83-91.

8. Ciftci B, Ekinci M, Celik EC, Kaciroglu A, Karakaya MA, Demiraran Y et al. Comparison of intravenous ibuprofen and paracetamol for postoperative pain management after laparoscopic sleeve gastrectomy. a randomized controlled study. Obesity surgery. 2019; 29(3):765-770.

9. Ekici NY, Alagöz S. The effectiveness of endoscopic sphenopalatine ganglion block in the management of postoperative pain after septal surgery. Int. forum of allergy & rhinology 2019; 9(12): 1521-1525.

10. Aksoy M, ?nce ?, Ahiskalioglu A, Keles S, Doymus O. Effect of intravenous preoperative versus postoperative paracetamol on postoperative nausea and vomiting in patients undergoing strabismus surgery: A prospective randomized study. Agri. 2018; 30(1):1-7.

11. Juan F, Ayiheng Q, Yuqin F, Hua Z, Jun Y, Bin H. Risk Factors of Chronic Rhinosinusitis After Functional Endoscopic Sinus Surgery. Med Sci Monit. 2017; 28(23):1064-1068.

12. Dalal S, Ninave S. Efficacy of intravenous paracetamol infusion for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation. Indian Journal of Sciences and Technology. 2019; 12(36):1-7.

13. Arslan M, Celep B, Çiçek R, Kalender HÜ, Y?lmaz H. Comparing the efficacy of preemptive intravenous paracetamol on the reducing effect of opioid usage in cholecystectomy. Journal of research in medical science.. 2013; 18(3):172-177

14. Atashkhoei S, Nikan F, Kardan R, Pourfathi H. Effect of Different Doses of Paracetamol on Postoperative Pain After Gynecologic Laparoscopy surgery. Int. J.Women health and Repr. Sci 2018; 6(3): 374-379.

15. Hassan HI. Perioperative analgesic effects of intravenous paracetamol: Preemptive versus preventive analgesia in elective cesarean section. Anesthesia, essays and researches. 2014; 8(3):339.

16. Majumdar S, Das A, Kundu R, Mukherjee D, Hazra B, Mitra T. Intravenous paracetamol infusion: Superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery. Perspect Clin Res. 2014; 5(4):172-177.

17. Bandey S, Singh V. Comparison between I/V paracetamol and Tramadol for post-operative analgesia in patients undergoing laparoscopic cholecystectomy. J Clin Diag Res. 2016; 10(8):05- 09.

18. Soltani G, Molkizadeh A, Amini S. Effect of Intravenous Acetaminophen (Paracetamol) on Hemodynamic Parameters Following Endotracheal Tube Intubation and Postoperative Pain in Caesarian Section Surgeries. Anesth Pain Med. 2015; 5(6):e30062.

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22. Mac TB, Girard F, Chouinard P, Boudreault D, Lafontaine ER, Ruel M, Ferraro P. Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study. Journal of cardiothoracic and vascular anesthesia. 2005; 19(4):475-478.

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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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