Pre-emptive Analgesic Effects of Intravenous paracetamol Versus diclofenac in open cholecystectomy

Pokharel A**, Karki AJ*


Introduction: Pain is not just a sensory modality but is an unpleasant experience. In order to improve the efficacy of perioperative pain treatment, there are modalities like: pre-emptive analgesia and multimodal pain therapy. Pre-emptive analgesia is reported as an effective management, which pharmacologically induces an effective analgesic state prior to the surgical trauma, thereby significantly reducing post operative analgesic (opioids) requirement.

Method: This was a prospective, randomized and double blind study. Fifty two patients of either sex, aged between 20 to 60 years, American Society of Anesthesiologist Physical Status I and II scheduled for open cholecystectomy requiring general anesthesia with endotracheal intubation was included in this randomized double bind study. Patients were divided into two groups. Thirty minutes prior to induction either inj. paracetamol 15 mg/kg (not exceeding 1 gm) or inj. diclofenac 1 mg/kg (not exceeding 75 mg) diluting in 100 ml of normal saline given over 20 minutes. Inj. pethidine 0.5 mg/kg iv was given for analgesia. Induction, maintenance and reversal were standardized in both the groups. Systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate were recorded in intraoperative period. Every patient was evaluated post operatively using pain scores (Numeric pain score 10 cm) in half an hour, 1, 2, 4, 8, 12 and 24 hours. Time duration of first rescue and total pethidine requirement in first 24 hours recorded and compared between the groups.

Result: The mean duration of first rescue pethidine in paracetamol group was 46.15±21.25 min whereas in diclofenac group was 35.88±10.13 min (P value 0.031). The mean dose of requirement of rescue pethidine in 24 hours was 109.38±35.22 mg in paracetamol group and 124.19±35.04 mg in diclofenac group (p value 0.135).

Conclusion: Pre-emptive iv paracetamol 15 mg/kg is effective than iv diclofenac 1 mg/kg for prolonging the duration of immediate post operative analgesia and reduces (13%) the total pethidine consumption in 24hours.

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