Intravenous propacetamol as postoperative analgesia in cesarean section : comparative study with intra-thecal morphine

الملخص EN

Introduction : the Provision of optimal analgesia after cesarean section remains a challenge, as.

Satisfactory pain relief must be balanced with the ability of the mother to care for her newborn.

(Cohen et al, 1992) Paracetamol is a non NSA1D commonly used in multimodal post-operative pain management (Flouvat et al, 2004).

The recent availability of propacetamol an injectable pro-drug of : paracetamol, has prompted the use of this well-known and safe analgesic in many clinical settings '?when the parenteral route is required (Van Aken et al, 2004).

Aim of this study was to evaluate the safety and efficacy of intravenous propacetamol in comparison with intrathecal morphine for postoperative analgesia following cesarean section. Patients and methods: The present study was carried out in Assiut University Hospital.

Eighty parturients undergoing elective cesarean section under spinal anesthesia were included.

The parturients were allocated randomly into four equal groups: Group I is the control group and received intrathecal bupivacaine 0.5%, 10-12.5 mg alone.

Group II received intrathecal bupivacaine 0.5% 10-12.5 mg combined with morphine 0.4 mg.

Group III received intrathecal bvpivacaine 0.5% 10-12.5 mg followed by i.v.

propacetamol 2g / 100mL saline after delivery of the baby and after 6 hours.

Group IVreceived intrathecal bupivacaine 0.5% 10-12.5 mg combined with morphine 0.2 mg followed by i.v.

propacetamol 2g / 1 OOmL saline after delivery of the baby and after 6 hours.

All patients in the four groups received I.M.

75 mg diclofenac at the end of surgery and after 8 hows.

When the Visual Analogue Scale (VAS) was 4cm or more, an additional postoperative I.M.

meperidine 50 mg as rescue medication was given.

Hemodynamic data were recorded immediately after induction and every 10 min till the end of the operation.

Neonatal outcome was assessed by Apgar score at one and 5 minutes.

Pain intensity score was assessed by VAS every hour and for 12 hours. Results: there were no significant differences between the four groups as regard demographic data, hemodynamics and the neonatal outcome.

The pain intensity was more in the control group, the I.

V.

propacetamol group was better than the control group but less than the intrathecal morphine group and the pain intensity was the least in the combined group.

The combined group was the best one, regarding the quality of pain relief and less side effects due to reduction in morphine dose.

The control group required more supplemental analgesia than the propacetamol group and no supplemental analgesia was required in groups II and IV.

Complications and side effects were minor.

Conclusion: This study may be too small to detect the analgesic effect of propacetamol.

The study is also too small to detect a reduction in side effects using multimodal therapy, if there is such a reduction.

Therefore, the role of propacetamol is still unknown and a further investigation, with sample sizes large enough to quantify side effects and patient safety, still need to be performed.