Journal of Anesthesiology and Pain

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Background and aims:

 Postoperative analgesia is one of the most concerns of anesthesiologist and patients. Systemic opioids administration is the gold standard in reducing the severe pain after surgery but some side effects prevent the use of adequate doses of opioids. The aim of this study was evaluation of adding acetaminophen on fentanyl in patient-controlled iv analgesia (PCIA).
Materials and Methods:

 In this randomized clinical trial, 120 patients candidate for lower limb orthopedic surgery (ASA I-II) were recruited in Rasoul-Akram Medical Center in a 12- month period. They randomly allocated  in two groups for postoperative pain, group F (Fentanyl)  (n=60)  and group AF (Acetaminophen/ Fentanyl) (n=60) by patient-controledl  intravenous analgesia (PCIA) groups. The pump has a continuous infusion of 5 ml per hour, bolus dose 2 ml and the lock out time 30 minutes was left. Each ml of solution in group F containing 10 mcg of fentanyl and in the group AF containing 5 mcg fentanyl and 20 mg acetaminophen. Pain score, sedation score, satisfaction, nausea and vomiting was evaluated for 48 hours after surgery.
Results:

The demographic characteristics of the two groups did not differ significantly. Pain scores beforpump  in F and AF groups were  6.8±1.6 and6.5±1.4, respectively. After 24 and 48 hours pain scores (2.4± 0.8, 1.7± 0.7) and (1.9± 0.6, 1.2± 0.5) decreased (P<0.001). Changes in pain scores were similar in both groups. Level of sedation, nausea and vomiting in the F group  and satisfaction in the AF group was higher. 
Conclusion:

 This study showed adding iv acetaminophen to fentanyl through an PCIA is effective in controlling pain in patients undergoing lower limb orthopedic surgery. Moreover, acetaminophen and fentanyl combination and has fewer side effects such as nausea, vomiting and sedation and more satisfaction than fentanyl alone.

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Aim and Background: Acetaminophen, in both oral and intravenous forms (Apotel), is a safe drug in controlling mild to moderate pain. However, Opioids are still a part of routine plan. We compared the effectiveness of Apotel with oral acetaminophen codeine and oxycodone for postoperative pain control. Methods and Materials: In this single blind clinical control trial, 75 patients, being candidate for elective septorhinoplasty, were enrolled and divided into 3 groups. All groups received 1000 mg Apotel in the recovery room then the first group received 900/30 mg oral acetaminophen codeine after 6 hours QID , the second group received 10 mg oxycodone after 8 hours TDS and the third group received 1000 mg Apotel after 8 hours TDS. Findings: All three regimens resulted in a significant pain reduction and there was no significant difference in the pain score at different intervals however Systolic blood pressure and Diastolic Blood pressure showed significant reduction in the aceminophen codeine and oxycodone group. Conclusions: Considering the significant pain reduction in all the three groups, selection between the 3 regimens should be based on other factors.

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Aim and Background:

Abdominal surgeries are usually very painful post-operatively for the patients consequently pain control would lead to a more rapid recovery period in patient and it would lower the complication rate.Nowadays intravenous Acetaminophen is one of the most prevalent drugs used in operating rooms to control pain.Ketamine also is an anesthetic drug, being a reasonable analgesic agent.This double blinded RCT has been done to compare the analgesic effect of paracetamol in comparison with ketamine on postoperative pain control after hysterectomy.

Methods and Materials:

Our patients were randomly allocated into two groups, according to the inclusion-exclusion criteria. The first group(40 patients) recieved 1 gram IV paracetamol and the second group (40 patients) recieved 0.15 mg per kg ketamine instead. The changes in blood pressure, heart rate, pain based on visual analogue score, and also the sedation Ramsay score were all evaluated at 4,6,12, and 24 hours after the operation. Moreover, nausea-vomiting and the amount of consumed analgesics were recorded and compared between the two groups

Findings:

 According to our findings, the VAS scoreand the total analgesic use were both significantly less in the Acetaminophen group in comparison with the ketamine group. However there was no significant difference found in regards to sedation score, nausea-vomiting, and respiratory problems. (p> 0.05)

Conclusions:

 Prescribing paracetamol at the end of abdominal hysterectomy is significantly more effective for pain control than intravenous ketamine.

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Aims and Background: Airway hyperactivity is one of the most important complications of tracheal extubation. This study was designed to compare the efficacy of intravenous acetaminophen as an alternative to remifentanil on airway response to tracheal tubes during and at the end of anesthesia in functional endoscopic sinus surgery.

Methods and materials: This study was conducted as a double blind clinical trial on 70 patients 20 to 60 years old, candidate for endoscopic sinus surgery, in Rasoul-Akram hospital. They were randomly allocated into two groups: the Paracetamol (n=35) and the remifentanil (n=35) groups. Remifentanil infusion with a dose of 0 /1μg/kg/min was administered for both groups during anesthesia . Since the beginning of inserting the nose tampon until extubation, remifentanil infusion (0/1 μg/kg/min ) was continued in group I, and in group II in the last 20 minutes of surgery , remifentanil infusion was discontinued and intravenous injection of acetaminophen was begun . Incidece of Cough, Arterial blood pressure, and heart rate were recorded.

Findings : There was no significant difference in the incidence rate of cough during extubation between the two groups (P=0.7). M ean arterial pressure (MAP) v ariation, was significantly lower in the remifentanil group (P<0.001). Variations in heart rate were similar in both groups ( P=0.74).

Conclusions: Using intravenous acetaminophen has the same effect as remifentanil in controling airway reflexes after endoscopic sinus surgery as well as reducing symptoms such as restlessness and changes in heart rate.

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 Aims and background: Post operative pain is the most common problem after surgeries. In the meanwhile, post operative pain in children is very important because tolerance to pain in children is lower; also use of opioid in children is limited. As using acetaminophen is increasing for pain relief, this study aimed to compare the effect of Acetaminophen with Morphine in decreasing post opearative pain in children undergoing laparoscopic apandectomy. Materials and Methods: In a clinical trial 80 children, candidate for apandectomy, were selected and randomly divided into two groups. The first group recevied 15 mg/kg acetaminophen in 100 ml normal saline and the second group received 0.01 mg/kg morphine intravenously and post operative pain and other complications such as nausea and vomitting and hemodynamic parameters during surgery and recovery were compared between the two groups. Data were analyzed by SPSS soft ware. Findings: According to Cheopsis score the mean post operative pain in the enterance to recovery in acetaminophen and morphine groups were 10.4±0.9 and 8.93±2, respectively and the difference between the two groups was statisticallysignificant (P<0.001). After 15 minutes in recovery the pain intensity in the two groups were 10.58±1.06 and 8.1±1.72, respectively and the difference was statisticallysignificant (P<0.001). The mean post operative painat the time of exit from recovery in acetaminophen and morphine groups were 10.28±1.2 and 8.03±1.8, respectively and the difference was again statistically significant (P<0.001). According to repeated measures ANOVA the trend of pain in the recovery was different between the two groups (P<0.001). conclusion: According to the results of the study, injection of acetaminophen before laparascopic apandectomy led to decreased post operative pain, decreased length of stay in recovery and decreased other post operative events such as nausea and vomitting. Therefore acetaminophen is a suitable replacement for control of post operative pain in children under laparoscopic apandectomy and this recommended except in the case of contraindication

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 Aims and background: Pain is one of the important factors in the acceptance of surgery in patients and may be the most important factor in the fear of surgery. The gold standard for controlling postoperative pain is the use of narcotic drugs, but its use is limited due to side effects. The present study was designed and performed with a comparative study betwwn the effect of infusion of ketorolac and acetaminophen on pain reduction and opioid use after surgery in patients undergoing orthopedic surgery of lower extremities. Materials and Methods: This study is a randomized double blind clinical trial. In this study, 100 patients undergoing orthopedic surgeries in the lower limbs with general anesthesia were randomly assigned to two groups of 50. The first group received 1 gr of acetaminophen every 6 hours intravenously, and the second group received 90 mg of ketorolac in 1 liter of normal saline serum for 24 hours. VAS system was used at 0, 12 and 24 hours to evaluate pain after surgery. In case of pain in patients, Meperidine was injected, and the dose of  Meperidine consumed was measured and recorded at the end. Finally, the data was analyzed. Findings: In this study, intravenous administration of acetaminophen was initially less effective than ketorolac infusion, but after 12 hours it was observed that the effect of acetaminophen on pain relief was greater than that of ketorolac. Also, the level of Meperidine was initially lower in the ketorolac group than in the acetaminophen group, but after 12 hours, Meperidine levels increased in the ketorolac group. It was also observed that the rate of nausea and vomiting in the ketorolac infusion group was significantly lower than that of the intravenous acetaminophen recipient group. However, the patient’s satisfaction with acetaminophen was more than that of the ketorolac infusion. conclusion: The results of this study showed that the effect of acetaminophen and ketorolac is different at different times. The pain reduction in the first 12 hours in the ketorolac group and the second 12 hours in the acetaminophen group significantly changed.

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Background: Pain relief after C/S is very important. Acetaminophen is one of the most common drugs to control post-operative pain. Due to the fact that Acetaminophen IV should be injected several times a day for patients, to save time, manpower and cost, it is recommended to inject intravenous Acetaminophen in 24-hour drip. Therefore, this study was designed and performed to compare Acetaminophen drip with routine IV injection on pain control after C/S surgery.
Methods: This interventional study was performed on 80 women who referred to Isfahan Family Hospital for C/S in 1396. Patients were divided into two groups of 24-hour drip and routine IV injection of Acetaminophen. Then postoperative pain and complications were evaluated in recovery and within 24 hours after surgery. Finally, the data were analyzed using SPSS.
Results: The mean score of postoperative pain in both groups was statistically significant (P-Value <0.05). The mean pain score in the Acetaminophen drip group was significantly lower than the routine IV Acetaminophen group (P-Value = 0.014). Mean Diastolic Blood Pressure in routine IV Acetaminophen group was significantly higher than Acetaminophen drip group (P-Value = 0.004). Drug side effects were higher in the routine IV Acetaminophen group. 
Conclusion:  This study showed that 24-hour Acetaminophen drip had better analgesic effects with fewer side effects than routine IV Acetaminophen injection after C/S surgery.