Pre-Emptive Analgesic Effect of Intravenous Paracetamol in Modified radical mastectomy

Bhawana Wagle,Deepak Mauni,Durga Khanal,Meg Raj Mandal,Pradeep Thapa,Sudhir Shrestha,Sujan Kandel,Sumit Singh,Suraj Vishowkarma,Yogesh Regmi

doi:10.3126/njc.v2i1.25646

Abstract

Background: Modified radical mastectomy (MRM) is associated with significant post-operative pain. Intravenous (iv) paracetamol provides pain relief in most patients who have undergone MRM. It has been observed from previous studies conducted on patients undergoing other surgeries like abdominal surgeries that the analgesic efficacy of iv paracetamol improves when used Pre-emptively. There are no studies done previously on use of iv paracetamol Pre-emptively in MRM. Objective: The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous (iv) paracetamol in MRM. Materials and Methods: Following institutional ethics committee approval, fourty American Society of Anesthesiology (ASA) physical status I-II patients were assigned in a randomized manner into two groups: Group I received iv paracetamol 1g, in 100mL, 15 minutes before induction and Group II received iv paracetamol 1g, in 100 mL, at the end of the surgery. The time to first analgesic use and the total analgesic consumed in 24 hours was recorded. Visual Analog Scale (VAS) pain scores were obtained from all patients at 0, 30 minutes, 1, 2, 6, 12 and 24 hours after the end of the Surgery. Results: Time to first analgesic requirement was significantly longer in Group I compared to Group II (p = 0.0329). Rescue analgesic consumption and post-operative VAS pain scores recorded were significantly lower in Group I compared to Group II (p < 0.05) until 24 after surgery. Conclusion: Pre-emptive iv paracetamol in comparison to intra- operative paracetamol, provided effective and reliable post- operative analgesia after modified radical mastectomy.

Highlights

A modified radical mastectomy is a procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes; the pectoralis major muscle is spared
We found no studies on paracetamol being used as a pre-emptive analgesic in modified radical mastectomy (MRM)
Arici and colleagues [8] have found that preemptively administered iv paracetamol 1g in patients undergoing a total abdominal hysterectomy operation had no negative effects on intra-operative or post-operative hemodynamic parameters, ensured an effective analgesia during the post-operative period, increased patient satisfaction by reducing post-operative morphine consumption and side effects, and thereby shortened the length of hospital stay

Summary

Introduction

A modified radical mastectomy is a procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes; the pectoralis major muscle is spared. Modified radical mastectomy (MRM) is associated with significant post-operative pain. Intravenous (iv) paracetamol provides pain relief in most patients who have undergone MRM. It has been observed from previous studies conducted on patients undergoing other surgeries like abdominal surgeries that the analgesic efficacy of iv paracetamol improves when used Pre-emptively. Objective: The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous (iv) paracetamol in MRM. Rescue analgesic consumption and post-operative VAS pain scores recorded were significantly lower in Group I compared to Group II (p < 0.05) until 24 after surgery. Conclusion: Pre-emptive iv paracetamol in comparison to intra- operative paracetamol, provided effective and reliable post- operative analgesia after modified radical mastectomy

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Conclusion