Comparing the effects of Acetaminophen, Meperidine, and their combination on postoperative pain management in elective cesarean section

Document Type : Original Article

Authors

1 Assistant professor, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Assistant professor, Department of Pharmacology, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

3 M.Sc., Department of Epidemiology, Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Introduction: Postoperative pain management is one of the most important challenges in Cesarean Section surgeries. Preventive analgesia is an effective approach in controlling this pain. This study was performed with aim to evaluate the efficacy of preventive analgesia and side effects of using acetaminophen, meperidine, and their combination after elective cesarean section under spinal anesthesia.
Methods: This double-blind randomized study was conducted on 120 full-term pregnant women with ASA class I undergoing elective Cesarean Section under spinal anesthesia at Shiraz Hafez hospital in 2017. The patients were randomly divided into three groups of each containing 40 patients. After delivery, during the clamping of umbilical cord and before the end of surgery, the drugs were injected to the patients. The patients received 15 mg/kg intravenous acetaminophen, 0.5 mg/kg intravenous meperidine, and a combination of them, respectively. After clamping the umbilical cord, the groups were compared in terms of postoperative pain severity and complications. Data were analyzed by SPSS software (version 22) and ANOVA and Chi-square tests. P<0.05 was considered statistically significant.
Results: The mean score of pain severity during the first six hours after the operation was significantly lower in the acetaminophen group compared to the meperidine group (P<0.001). The mean score of pain severity, duration of recovery, and time interval between the initial and the next administration of additional analgesics doses was significantly lower in meperidine plus acetaminophen group compared with other groups (P<0.001). Moreover, incidence of postoperative headache was significantly higher in meperidine group and shivering was significantly higher acetaminophen group (P=0.005).
Conclusion: Acetaminophen had a higher efficacy in postoperative pain management compared to meperidine, and their combination had greater analgesic effect and lower side effects.

Keywords

References

  1. Darvish H, Ardestani BM, Shali SM, Tajik A. Analgesic efficacy of diclofenac and paracetamol vs. meperidine in cesarean section. Anesth Pain Med 2014; 4(1):e9997.
  2. Fassoulaki A, Staikou C, Melemeni A, Kottis G, Petropoulos G. Anaesthesia preference, neuraxial vs general, and outcome after caesarean section. J Obstet Gynaecol 2010; 30(8):818-21.
  3. Qublan H, Merhej A, Dabbas MA, Hindawi IM. Spinal versus general anesthesia for elective cesarean delivery: a prospective comparative study. Clin Exp Obstet Gynecol 2001; 28(4):246-8.
  4. Shen X, Wang F, Xu S, Ma L, Liu Y, Feng S, et al. Comparison of the analgesic efficacy of preemptive and preventive tramadol after lumpectomy. Pharmacol Rep 2008; 60(3):415-21.
  5. Inal M, Celik N, Tuncay F. Iv paracetamol infusion is better than iv meperidine infusion for postoperative analgesia after caesarean section. Internet J Anesthesiol 2007; 13(1):112-9.
  6. Eydi M, Golzari SE, Aghamohammadi D, Kolahdouzan K, Safari S, Ostadi Z. Postoperative management of shivering: a comparison of pethidine vs. ketamine. Anesthesiol Pain Med 2014;4(2):e15499.
  7. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 2005; 102(4):822-31.
  8. Kolahdouzan K, Eydi M, Mohammadipour Anvari H, Golzari SE, Abri R, Ghojazadeh M, et al. Comparing the efficacy of intravenous acetaminophen and intravenous meperidine in pain relief after outpatient urological surgery. Anesthesiol Pain Med 2014; 4(5):e20337.
  9. Yazdani J, Ghavimi MA, Hajmohammadi S, Zarrintan S. Acute pain control by Pethidine versus intravenous acetaminophen in maxillofacial surgeries: a double blind randomized-controlled trial. J Am Sci 2013; 9(7):51-5.
  10. Omar A, Issa K. Intravenous paracetamol (Perfalgan) for analgesia after cesarean section: a double blind randomized controlled study. Rawal Med J 2011; 36(4):269-73.
  11. Shipton E. Should New Zealand continue signing up to the pethidine protocol? New Zealand Med J 2006; 119(1230):1875.
  12. Uysal HY, Takmaz SA, Yaman F, Baltaci B, Başar H. The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children. J Clin Anesth 2011; 23(1):53-7.
  13. Wininger SJ, Miller H, Minkowitz HS, Royal MA, Ang RY, Breitmeyer JB, et al. A randomized, double-blind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. Clin Ther 2010; 32(14):2348-69.
  14. Amrimaleh P, Alijanpour E, Zabihi A, Attarzadeh H, Shirkhani Z, Rezaee B, et al. Comparison of analgesic effect of intravenous paracetamol plus meperidine and meperedine alone on postoperative pain after elective cesarean. Anesthesiol Pain 2013; 4(3):1-7.
  15. Macario A, Royal MA. A literature review of randomized clinical trials of intravenous acetaminophen (paracetamol) for acute postoperative pain. Pain Pract 2011; 11(3):290-6.
  16. Hassan HI. Perioperative analgesic effects of intravenous paracetamol: preemptive versus preventive analgesia in elective cesarean section. Anesth Essays Res 2014; 8(3):339-44.
  17. Varrassi G, Marinangeli F, Agro F, Aloe L, De Cillis P, De Nicola A, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg 1999; 88(3):611-6.
  18. Landwehr S, Kiencke P, Giesecke T, Eggert D, Thumann G, Kampe S. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery. Curr Med Res Opin 2005; 21(10):1569-75.
  19. Juhl GI, Norholt SE, Tonnesen E, Hiesse‐Provost O, Jensen TS. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as a 2 g starting dose following third molar surgery. Eur J Pain 2006; 10(4):371-7.
  20. Van Aken H, Thys L, Veekman L, Buerkle H. Assessing analgesia in single and repeated administrations of propacetamol for postoperative pain: comparison with morphine after dental surgery. Anesth Analg 2004; 98(1):159-65.
  21. Rawal N, Allvin R, Amilon A, Ohlsson T, Hallén J. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol. Anesth Analg 2001; 92(2):347-51.
  22. Tabari M, Alipour M, Asadpour A, Mogharabian N, Amini S. A comparison between intravenous acetaminophen (Paracetamol) and intravenous meperidine in postoperative pain reduction of patients undergoing appendectomy. Age 2014; 20(20):40.
  23. Alhashemi J, Daghistani M. Effects of intraoperative iv acetaminophen vs im meperidine on post-tonsillectomy pain in children. Br J Anaesth 2006; 96(6):790-5.
  24. Atef A, Fawaz AA. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryngol 2008; 265(3):351-5.
  25. Beaver WT. Combination analgesics. Am J Med 1984; 77(3):38-53.
  26. Taneja A, Kaur T, Sood IV. Comparative study on the effect of paracetamol, diclofenac and their combination in post operative pain relief of cesarean section. JK Sci 2015; 17(1):30.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 3
May 2019
Pages 1-7

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