The efficacy of Intravenous paracetamol versus Intrathecal morphine in post cesarean section analgesia
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Abstract
The efficacy of Intravenous paracetamol versus Intrathecal morphine in post cesarean section analgesia
Nuttanapat Wetchakan, M.D. Nataporn Naknoi B.N.S. Nuchjira Phiphitchuanchom B.N.S.
Department of Anesthesiology, Kamphaeng Phet Hospital
Abstract
Background: Cesarean section is common procedure in obstetric and gynecology. Postoperative pain is an avoidable problem. Nowadays, Intrathecal morphine is a conventional technique for postoperative pain control after cesarean section. Although it provides excellent pain control but has many side effects. Intravenous paracetamol has increasingly used in clinical practice. It provides good pain control, reduces opioid use and has minimal side effect.
OBJECTIVE: To compare the analgesic efficacy and side effect profile of intravenous paracetamol versus intrathecal morphine in women undergoing cesarean section
METHODS: A therapeutic research with double-blinded, randomized controlled trial was conducted in Kamphaeng Phet Hospital from 1st June to 31stAugust 2020. 160 women undergoing cesarean section under spinal anesthesia were divided in two groups (80 in each group). Control group : Spinal anesthesia was done with 0.5%hyperbaric bupivacaine+morphine then Normal Saline Solution (NSS) 100 ml was given 6 hourly for 24 hours. Study group : Spinal anesthesia was done with 0.5%hyperbaric bupivacaine then intravenous paracetamol 1 gm (100 ml) was given 6 hourly for 24 hours. We recorded visual analogue pain score (at rest and during movement) measured 1,6,12,24 hours after sugery, total tramadol and pethidine consumption and side effects.
RESULTS: No difference between group in Age, Gestrational age, Weight, Height, Body Mass Index (BMI) and Operation time. The mean pain scores at rest at 1,6,12,24 after surgery in study group were 0.01±0.11, 4.97±1.88, 4.92±1.72, 3.56±1.52 and in control group were 0, 2.33±1.54, 3.31±1.68, 3.62±2.00. The mean pain scores during movement in study group at 1,6,12,24 after surgery were 0.06±0.29, 6.47±2.03, 6.21±1.81, 4.8±1.7 and in control group were 0, 3.83±2.13, 5.02±1.98, 5.08±2.29. The mean pain scores were not difference at 1 and 24 hours after surgery. The mean pain scores in study group were significantly higher than control group at 6 and 12 hours after surgery (p<0.001).Total tramadol and pethidine consumption in study group were significantly higher than control group. Side effects were found in control group (nausea/vomiting 23%, pruritus 60%) but were not found in study group.
CONCLUSION AND DISCUSSION: The analgesic efficacy of intravenous paracetamol was not equal to intrathecal morphine at 6 and 12 hours after surgery. Intrathecal morphine has higher incidence of side effects than intravenous paracetamol. In new practice, Intravenous paracetamol may be used in patients who had experience of serious side effect from previous opioid use. We may use intravenous paracetamol with other analgesic drugs to increase analgesic effect and decrease side effect.
Keyword: cesarean section, postoperative pain, intravenous paracetamol, intrathecal morphine
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References
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