Abstract
Background: According to previous studies there are some different opinions on the pre-emptive effects of paracetamol in controlling post-operative pain, we aimed to compare the analgesic effects of pre-emptive paracetamol with post-operative paracetamol and morphine in patients undergoing septorhinoplasty.
 Materials and methods: A hundred and six patients aged 15 to 50 were divided into 3 groups. One received 1 g paracetamol 30 minutes before the operation, another group received 1 g paracetamol after the surgery and the control group received 3 mg morphine sulfate in the recovery room after the surgery. The pain severity was recorded for each patient using a 10 slot table. Any signs of nausea and vomiting (N/V) or apnea were closely observed and recorded. Patients with pain score 5 or more received 2 mg morphine intravascularly.
 Results: There was not any significant difference between the groups in total pain score and N/V (p>0.05). Post-operative morphine intake was significantly lower in pre-emptive group (P<0.05). None of the patients experienced apnea during the study. 
 Conclusion: We concluded that pre-emptive paracetamol can lower the opium consumption in post-operative period but pre-emptive paracetamol cannot reduce the post-operative acute pain noticeably.
Highlights
Controlling post-operative pain is an important issue and very little is known about the outcomes of not handling the problem [1]
Group C had the highest mean in total pain score (15.32±4.75), while post-operative group (PO) and Pre-emptive group (PE) groups showed lower scores (12.80±6.23 and 13.43±5.64, respectively), but there were no significant differences in this regard among the groups (p>0.05)
Patients with pain score more than 5 received extra intravenous morphine; of them 32.3% were in group C, 15.6% in PE group, and 37.5% were from PO group
Summary
Controlling post-operative pain is an important issue and very little is known about the outcomes of not handling the problem [1]. Pre-emptive analgesia has three goals in pain treatment: to calm the pain caused by inflammatory agents at the surgical excision site, to prevent the pain memory response of the central nervous system (CNS), and to control post-operative pain in order to prevent chronic pain development. Drugs such as Paracetamol have been under investigation as a pre-emptive analgesic agent [11]. The purpose of this study was to evaluate the pre-emptive analgesic effects of intravenous Paracetamol compared to post-operative intravenous Paracetamol and morphine sulfate in controlling acute postoperative pain in patients who underwent septorhinoplasty. Conclusion: We concluded that pre-emptive Paracetamol can lower opium consumption in post-operative period but pre-emptive Paracetamol cannot reduce post-operative acute pain noticeably. [GMJ.2015;4(2):121-25]
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