A Prospective Randomized Double-blind Controlled Study Comparing Intravenous Paracetamol Plus Fentanyl and Intravenous Fentanyl Alone for Post-operative Analgesia for Laparoscopic Cholecystectomy
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 6
Abstract
Background: Acute pain after laparoscopic cholecystectomy is complex in nature which shows individual variation in intensity and duration; therefore, adequate pain control is mainstay during post-operative period. This study compares the effect of intravenous (IV) paracetamol plus IV fentanyl and fentanyl alone for analgesic efficacy, intraoperative hemodynamic, opioids sparing effects, and opioid-related side effects after laparoscopic cholecystectomy. Aim of the Study: The aim of the study was to determine the efficacy of IV paracetamol for post-operative analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia and to compare the occurrence of opioid-sparing effects in patients receiving IV fentanyl plus IV paracetamol and IV fentanyl alone postoperatively. Materials and Methods: A total of 60 patients undergoing laparoscopic cholecystectomy were randomized into two groups. In Group A, IV paracetamol 1 g (100 mL) was administered 10 min before induction. Group B served as a control group and received saline normal saline 100 mL. Both groups received fentanyl during induction. Intraoperative hemodynamic such as heart rate, mean arterial pressure, and intraoperative fentanyl consumption was measured and recorded. The post-operative pain relief was evaluated by a visual analog scale (VAS) score, consumption of fentanyl as rescue analgesia, and sedation scores, the incidence of post-operative nausea and vomiting (PONV) and pruritus was measured in the post-operative period. Observations and Results: The mean VAS score in immediate and 1 h after surgery was less in the group receiving IV paracetamol (3.03 ± 0.41* vs. 3.53 ± 1.04; 3.13 ± 0.57* vs. 3.90 ± 1.21); the fentanyl consumption intraoperatively was less in the paracetamol group (41.50 ± 32.40* vs. 84.66 ± 32.32*), overall intraoperative hemodynamic was stable in paracetamol group. The time requirement of the first dose of rescue analgesic in the post-operative period was also significantly prolonged in the group receiving IV paracetamol (5.84 ± 4.44 *vs. 1.83 ± 1.09). The sedation scores at 1st, 6th, and 12th h were less in paracetamol group (1.43 ± 0.67* vs. 1.83 ± 0.64; 1.20 ± 0.40* vs. 1.56 ± 0.72; and 1.10 ± 0.30* vs. 1.43 ± 0.50). There was no difference in the incidence of PONV and pruritus in the two groups. Conclusion: The use of IV paracetamol 1 g for preemptive analgesia as an adjunct to IV fentanyl in patients undergoing laparoscopic cholecystectomy had better intraoperative hemodynamic parameters, good quality postoperative analgesia, reduced consumption of fentanyl doses, and lesser sedation in post-operative period.
Authors and Affiliations
Sapna Atram Madukar, Venkanna Pocham
Keywords
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