Intravenous Paracetamol Research Articles

Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study

ABSTRACT PURPOSE: To evaluate (i) acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation by the patients and (ii) accuracy of a set of clinical criteria for diagnosis of simple anal fistula. METHODS: A set of clinical criteria based on physical findings was used to diagnose patients with simple anal fistula. These patients were operated under local anesthesia with conscious sedation. Intravenous paracetamol, diclofenac sodium, and midazolam were administered as adjuvants. Fistulotomy with/without marsupialisation was performed in most patients. Clinical diagnosis was matched with operative findings. RESULTS: Among 193 patients presenting with anal fistula, 61 patients were diagnosed as simple anal fistula and were scheduled for surgery under local anesthesia with conscious sedation. One patient was found to have complex anal fistula during intraoperative assessment and surgery was deferred. Surgery could be completed under local anesthesia with conscious sedation for 58/60 (96.7%) patients. Acceptability of the procedure was assessed with two parameters: the patients’ satisfaction score on visual analogue scale and their willingness to undergo fistula surgery under local anesthesia again, if required. Median (interquartile range) visual analogue scale score for patients’ satisfaction was 10 (9-10). All the patients expressed their willingness to undergo fistula surgery under local anesthesia again, if required. The clinical criteria was successful in diagnosing simple anal fistula in 58/61 (95.1%) patients. The remaining three patients had high intersphincteric fistula (1) and blind sinus (2). CONCLUSIONS: Acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation was excellent. The proposed clinical criteria were highly accurate in diagnosing simple anal fistula.

Comparison of intravenous Paracetamol with oral Ibuprofen for medical closure of PDA (patent ductus arteriosus) in preterm newborns – can it be an effective, safe and preferable choice?

Introduction: In prematurely born newborns, the ductus arteriosus frequently fails to close and more than half of preterms might have Patent Ductus Arteriosus (PDA) after birth during the first 24hours. About 70% of infants born before 28 weeks may require medical or surgical closure of PDA. Objectives: To compare the effect of i/v PCM and oral Ibuprofen on PDA closure rate in preterm neonates with a gestational age of > 37 weeks and evaluate the side effect profile of both drugs. Material and Methods: This time-bound prospective observational study for comparison of the efficacy of the two drugs on the closure of PDA in preterms admitted during 1.5 years of the study period in a neonatal ICU caring for inborn as well as outborn neonates in central India. After approval of the institutional ethics committee, initial clinical screening included all preterms but only those with PDA (open ductus arteriosus) confirmed by 2D-echocardiography were allocated to receive either of two treatment regimens (3-day courses of each oral Ibuprofen and i/v PCM) which already exist as evidence-based therapeutic practice options. Result: Out of a total of 43 cases clinically suspected on initial screening, 30 preterm babies confirmed by 2D-Echo to have PDA were finally enrolled and analysed. Twenty-one patients received i/v PCM with a resultant PDA closure rate of 85.7 % (n = 18/21), while nine cases could be allocated oral Ibuprofen arm and ductus closure was obtained in seven patients (77.78%). Although the PDA closure rate between two drug regimens was not statistically significant (p=0.593), i/v PCM resulted in slightly higher efficacy and fewer adverse effects. Conclusion: Paracetamol, preferably by the intravenous route, seems to be an effective, cheap, easily available and safe first-line alternative to oral Ibuprofen for the closure of PDA, especially in newborns with extreme prematurity, who are initially intolerant to oral feeds or drugs.

English

BACKGROUND Paracetamol has been commonly used for perioperative pain management. The perceived benefits of IV paracetamol (PCM) over oral are few if oral PCM is given sometime before surgery. We wanted to compare the effects of oral and intravenous paracetamol on perioperative pain management in patients undergoing total abdominal hysterectomy under general anaesthesia. METHODS Sixty-four female patients of American Society of Anesthesiologists (ASA) I / II, in the age group of 18 - 70 years, weighing 40 - 80 Kg, undergoing total abdominal hysterectomy (TAH) were randomised using computer-generated random number table, into two groups. They received oral dispersible 1 g PCM tablets (group PO) at least 45 minutes prior to surgery or intravenous (IV) PCM 1 g (group PI) after induction of anaesthesia. VAS pain scores were recorded and rescue analgesia with tramadol was provided postoperatively. RESULTS The primary outcome measure, time to first rescue analgesic, was statistically similar in both groups. The secondary outcome measures i.e., pain scores, postoperative 24 hours tramadol requirements, patient satisfaction scores and complications were also comparable. CONCLUSIONS Considering the similar efficacy and side effect profile but a much lower cost of oral PCM, routine administration of oral PCM 45 minutes before induction of anaesthesia may be an acceptable alternative to routine intraoperative IV PCM infusion. KEY WORDS Paracetamol, Intravenous, Oral, VAS Pain Score, Analgesia

Ethanol toxicity in a dog due to gin‐soaked sloe berry (Prunus spinosa) ingestion

AbstractA 10‐month‐old male Labrador retriever was presented for acute onset altered mentation and inability to walk. The dog was presented with a modified glasgow coma scale (MGCS) of 12 with tachycardia (148 bpm) and hypothermia (37°C). The dog had been normal the previous night then found semi‐comatose at the following morning. Investigations included haematology, biochemistry, C‐reactive protein, magnetic resonance imaging, urine toxicology and cerebrospinal fluid analysis. Ten hours after being found the dog passed faeces containing a significant volume of berries. The owner later determined that 750 g of sloe berries soaked in gin were missing from the garden compost heap. Serum ethanol concentrations measured approximately 20 hours after the suspected consumption were 310 mgD/L. The dog was treated with intralipid, intravenous fluid therapy and paracetamol. He was neurologically normal (MGCS = 0) 24 hours later, following diagnosis and treatment. Differential diagnosis and management of the comatose dog and management of ethanol toxicity are discussed.

Management of Postcaesarean Delivery Analgesia-Diclofenac Suppository, Paracetamol Infusion and a Combination

Introduction: One of the most important aspect of postoperative care is pain management which plays an important role in early recovery and improves patient’s general condition. Paracetamol and diclofenac have an excellent safety profile when compared to opioids. Aim: To assess and compare the analgesic efficacy and safety of individual use of Intravenous (IV) paracetamol, diclofenac suppository and in combination. Materials and Methods: This hospital-based cross-sectional study was conducted from October 2018 to June 2020 at Department of Obstetrics and Gynaecology. A total of 90 women who underwent caesarean section were recruited for the study and were randomly allocated (lottery method) into three groups with 30 participants in each group. The patients underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia with the same technique and medicine, (Bupivacaine 0.5%) without receiving any sedation. Group A patients received diclofenac suppository 50 mg every eight hourly, Group B received paracetamol infusion 1000 mg every eight hourly and Group C received 50 mg diclofenac suppository and 500 mg IV paracetamol every eight hourly. Pain severity (Visual Analogue Scale (VAS) score), Heart Rate (HR), Blood Pressure (BP) and side-effects were evaluated at 2,4,6,8,12 and 24 hours postoperatively. Patient satisfaction score was evaluated 24 hours after caesarean section. Results: Age range of participants was 19 to 28 years. Mean duration of surgery (minutes) in each group were- Group A-56.5±7.49, Group B-58.27±8.06 and Group C-56.97±6.78, respectively. There was a significant reduction of pain in patients receiving paracetamol and diclofenac suppository combination group. The satisfaction score was categorised as excellent by 80% patients in Group C. In Group A 30% and in Group B 16.6% categorised as excellent patient satisfaction score. The adverse effects such as nausea and epigastric discomfort was higher (7.7%) with diclofenac suppository group followed by Paracetamol (2.2% side-effects) and minimal with combination (1%). Conclusion: Paracetamol infusion is as effective as diclofenac suppository in reducing postoperative pain following caesarean section. Diclofenac suppository and IV paracetamol combination provides more effective postoperative analgesia compared with individual usage of IV paracetamol or diclofenac suppository in patients following caesarean section. The combined use of paracetamol and diclofenac suppository has fewer side-effects compared with individual use of either IV paracetamol or diclofenac suppository.

Analgesic effect of paracetamol monotherapy vs. the combination of paracetamol/parecoxib vs. the combination of pethidine/paracetamol in patients undergoing thyroidectomy.

IntroductionThe purpose of this study was to investigate the analgesic effect of 3 different regimens of combination analgesics administered to patients undergoing thyroidectomy.Material and methodsA total of 152 patients undergoing total or subtotal thyroidectomy were enrolled. Patients allocated to group A received a combination of intravenous (IV) paracetamol and intramuscular (IM) pethidine, patients in group B received a combination of IV paracetamol and IV parecoxib, while patients in group C received IV paracetamol monotherapy.ResultsThe analgesic regimens of groups A and B were found to be of equivalent efficacy (p-value = 1.000). In contrast, patients in group C (paracetamol monotherapy) had higher numerical rating scale scores, compared to both patients in groups A (p-value < 0.001) and B (p-value < 0.001).ConclusionsThe combinations of IV paracetamol with either IM pethidine or IV parecoxib are superior to IV paracetamol monotherapy in achieving pain control in patients undergoing thyroid surgery.

Flank pain from postherpetic neuralgia and role of erector spinae plane block

Flank pain from postherpetic neuralgia and role of erector spinae plane block

A Randomised Clinical Trial on Analgesic Efficacy of Intravenous Paracetamol as an Adjunct to Patient Controlled Epidural Analgesia with Ropivacaine and Fentanyl in Labour

Introduction: Intravenous (i.v.) paracetamol is considered as an effective and safe analgesic agent in labouring women, but its effect on patients already receiving epidural analgesia is not well documented. Aim: To know whether i.v. paracetamol reduces epidural local anaesthetic opioid combination consumption in labour by virtue of its analgesic effects. Materials and Methods: The present double blind, randomised clinical study was conducted on 88 singleton term pregnant women in active labour. Half of these women (n=44, Group P) received 1000 mg (100 mL) i.v. paracetamol and rest (n=44, Group C) received 100 mL normal saline as placebo (n=44). Thirty minutes later all women received 10 mL of ropivacaine 0.125% with 2 μg/mL fentanyl through epidural catheter, followed by continuous background epidural infusion of 5 mL/h with a provision of patient controlled bolus 5 mL of same drug with a lock-out interval of 15 minutes. The primary outcome was hourly mean consumption of epidural drug in mL. Results: The hourly mean drug consumption in the paracetamol group was significantly lower as compared to control group (7.75±0.93 mL/hr vs. 8.23±0.99 mL/hr; p=0.022). The mean number of boluses needed by parturient were also significantly less in the paracetamol group (0.58±0.66 vs. 1.02±0.82; p=0.005). Pain relief after epidural placement was adequate in both groups with similar Visual Analogue Scale (VAS) values without significant intergroup differences. Conclusion: It can be concluded that 1000 mg i.v. paracetamol is a safe and effective adjunct to Patient Controlled Epidural Analgesia (PCEA).

Efficacy of intravenous paracetamol infusion for prolongation of analgesia under spinal anesthesia for myomectomy

Objective: To assess the effectiveness of intravenous (iv) paracetamol (PCM) infusion in prolonging the duration of analgesia following spinal anesthesia and to determine patients’ satisfaction with pain relief. Materials and Methods: This was a double-blind, randomized, controlled study. A total of 126 adult American Society of Anesthesiologists physical status I or II women scheduled for elective myomectomy under spinal anesthesia were enrolled in the study. Patients were randomly allocated into two groups. PCM group (group A) [n = 63] received 100mL of 1g PCM and Normal saline group (group B) [n = 63] received 100mL of normal saline after spinal anesthesia was established. Statistical analysis was done using Statistical Package for Social Sciences, version 17. Results: There was no statistical difference between the groups in terms of age, weight, and body mass index. The mean time to first analgesic demand was 4.75 ± 1.59 h in group A and 2.23 ± 0.15 h in group B (P < 0.001), while the mean dose of additional analgesic was significantly lower in group A (11.81 ± 2.50 µg) when compared to group B (255.49 ± 140.80 µg), P < 0.001. In group A, 75.8% expressed excellent satisfaction with pain relief while 62.9% of patient in group B reported poor satisfaction with pain relief (χ2 = 87.600, P < 0.001). Conclusion: Intravenous infusion of 1g PCM is effective in prolonging the duration of analgesia following spinal anesthesia for myomectomy.

Genel Anestezi Altında Endovenöz Lazer Ablasyonunda Preemptif İntravenöz İbuprofen ve Parasetamolün Postoperatif Analjezi Etkinliğinin Karşılaştırılması

Objectives: The aim of this study is to compare the effects of preemptive intravenous ibuprofen and paracetamol on acute pain scores, opioid consumption and patient satisfaction in patients who will undergo endovascular laser ablation under general anesthesia. Methods: After induction, 1 g Paracetamol for Group P or 800 mg Ibuprofen for Group I was administered as a slow infusion by a separate intravenous route. Both drugs were followed by a repeat dose every 6 h until discharge. Visual analogue scale (VAS) was used for pain intensity at PACU and after the first, second, sixth hour after surgery. In case of acute pain (VAS ≥ 40) 1 mg intravenous morphine was used as a rescue drug. VAS scores, length of stay, total opioid consumption and patient satisfaction status was evaluated before discharge. Results: A total of 82 patients (42 in Group P and 40 in Group I) were included. There was no difference between the VAS scores. Total morphine consumption was 0.33 ± 0.47 in Group P, and 0.30 ± 0.43 in Group I (p = 0.42). Hospital length of stay was 6.4 ± 1.7 hours in Group P and 6.2 ± 1.4 hours in Group I (p = 0.51). Patient satisfaction status evaluated at discharge was found to be similar. Conclusion: There is no difference between preemptive intravenous paracetamol and ibuprofen in patients undergoing EVLA under general anesthesia in terms of postoperative acute pain scores and opioid consumption. Both drugs can be safely applied in this type of surgery.

Paracetamol for closure of patent ductus arteriosus in preterm babies born before 32-week gestational age: academic unit experience

Background: It remains unclear which treatment approach is most advantageous for closure of patent ductus arteriosus (PDA) in preterm infants. Despite the presence of previous trials and meta-analysis, a correct and univocal strategy for closure of PDA is still under debate. Till now, standard medical treatment for PDA closure has been indomethacin/ibuprofen, percutaneous transcatheter closure, or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of this study was to present our experience with intravenous (IV) and oral paracetamol for closing PDA in preterm neonates born before 32-week gestational age (GA). Patients and Methods: We conducted a prospective study in a neonatal intensive care unit (NICU) from a tertiary hospital in Minia University; Egypt. Eighty-seven preterm neonates born before 32-week GA with hemodynamically significant PDA (hsPDA) were enrolled. They received 15 mg/kg/6 h for 5 days IV or oral paracetamol for ductal closure. Our NICU guidelines before the current study state that only hsPDA is treated with oral ibuprofen based on the decision of the neonatologist after discussion with pediatric cardiologist. The study aims to vary the practice to use IV or oral paracetamol instead of ibuprofen to avoid side effects of nonsteroidal drugs in preterm babies. Results: During the study period, 140 babies

Preemptive Intravenous Paracetamol with or without Tramadol for Postoperative Pain After Elective Abdominal Surgery: a retrospective study

Introduction and aim: Prevention or reduction of postoperative (PO) pain is still a challenge, as it had a different drawbacks on the healing process and patient quality of life. The current study aimed to evaluate the value of preemptive paracetamol with or without tramadol in management of postoperative pain control after abdominal surgery.&#x0D; Methodology: This is a retrospective study of 90 patients who submitted to elective abdominal surgery. Patients were classified into three equal groups. The first for paracetamol, the second for paracetamol-tramadol and the third for placebo (saline). One hour before surgery a dose of paracetamol (1 gm diluted in 100 ml saline) was administered for the first two groups, in addition to 100 mg of intravenous tramadol to the second group. The primary outcome was PO pain in the first 24 hours after surgery. The secondary outcomes include time for the first analgesic request and cumulative dose of analgesia. Also, nausea and vomiting were documented. &#x0D; Results: The group of paracetamol-tramadol was associated with significant lower VAS score at 4, 6, 8, 10 and 12 hours postoperatively than paracetamol alone or saline groups. Time to the first analgesic request was significantly longer in paracetamol-tramadol (138.00±24.41 minutes) than paracetamol alone (100.0±31.84 minutes) or saline group (82.33±23.73 minutes). The total cumulative analgesia in the first PO Day was significantly lower in paracetamol-tramadol (158.33±79.96 mg) than paracetamol (245.00±73.52 mg) or saline group (276.67±75.12 mg). Nausea and vomiting were reported in 9, 8 and 10 in paracetamol, paracetamol-tramadol and saline groups respectively with no significant differences.&#x0D; Conclusion: The use of preemptive paracetamol alone or combined with tramadol is an effective intervention to reduce the postoperative pain after abdominal surgery. It reduces the use of postoperative analgesics with subsequent effect on the cost and healthcare system.

Analgesic and opioid sparing effects of preoperative thoracic paravertebral block: A double blind evaluation of 0.5% bupivacaine with adrenaline in patients scheduled for simple mastectomy.

Various regional anaesthetic techniques are used for post-mastectomy pain relief; however, thoracic paravertebral block (TPVB) has shown some advantages over other methods. This study sought to demonstrate the post-operative benefit of pre-operative TPVB in patients scheduled for simple mastectomy. The study was carried out on 60 adult female patients with the American Society of Anesthesiologists physical status Class I to III scheduled for unilateral mastectomy. Pre-operatively, a nerve stimulator was used to locate the paravertebral space thereafter bupivacaine with adrenaline or saline was injected into the space. Post-operatively, intravenous morphine patient controlled analgesia was commenced in the two groups for 24 h after the surgery. In addition, intravenous paracetamol 15 mg/kg was administered 6 hourly for 24 h in both groups. The 24 h morphine consumption was significantly reduced in the bupivacaine group compared to the control group (P = 0.000). The Numerical pain rating score was significantly lower in the bupivacaine group than in the control group in the 1st 6 h; P = 0.001. The time to first request for analgesia was significantly longer in the bupivacaine group than the control group (P = 0.000). Nausea was the major side effect detected and this was significantly higher in the control group (P = 0.024). The morphine sparing effect was 65.7% in the bupivacaine group. The study showed that bupivacaine-based TPVB provided an effective post-operative analgesic and opioid-sparing effect for simple mastectomy when compared with a saline-based control group that received only intravenous morphine patient controlled analgesia and paracetamol.

Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial.

OBJECTIVE:Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis.METHODS:This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min.RESULTS:One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350).CONCLUSION:Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.

Parecoxib Vs Paracetamol for Treatment of Acute Renal Colic Due to Ureteric Calculi: A Randomized Controlled Trial

To compare efficacy and safety of parecoxib and paracetamol for treatment of acute renal colic due to ureteric stones. A randomized, double blinded, controlled trial included adult patients presented to emergency department with acute renal colic due to ureteric calculi between June 2019 and August 2020. Patients with hypersensitivity to either drug, peptic ulcer, coronary ischemia, peripheral vascular or cerebrovascular disease, hepatic impairment (Child-Pugh score >10) or chronic kidney disease stage 4 or 5 were excluded. Eligible patients were randomized to group 1 who received 1g intravenous Paracetamol infusion or group 2 who received 40mg intravenous Parecoxib infusion. Pain analogue score was evaluated before treatment and 30 minutes afterwards. The primary endpoint was the need for rescue analgesia for persistent pain. Safety was evaluated by the incidence of adverse events. The study included 203 patients (102 in group 1 and 101 in group 2). Pretreatment patients' data were comparable for both groups. The mean pain analogue score decrease from 7.6 to 3.8 in paracetamol group (P <.001) and from 7.8 to 3.4 in parecoxib group (P <.001). Rescue analgesia were needed in 36 patients (35.3%) in paracetamol group and 27 patients (26.7%) in parecoxib group (P=.187). Minor adverse events developed in 2 patients (2%) in paracetamol group and 3 patients (3%) in parecoxib group (P=0.683). Paracetamol and Parecoxib were effective for treatment for patient with acute renal colic. Both treatments showed comparable results in reduction of pain and need for rescue analgesia with minimal adverse events.

Intravenous versus oral paracetamol for postoperative analgesia: A systematic review.

Paracetamol is a widely used analgesic agent that can be given by several different routes of administration. In the surgical setting, intravenous infusions of paracetamol are used, but an alternative is using oral paracetamol as a premedication. This systematic review is the first to compare the relative efficacy of intravenous and oral paracetamol at providing postoperative analgesia. Nine relevant studies were identified. Intravenous paracetamol resulted in a postoperative pain score of 0.5 points lower than in those receiving oral paracetamol premedication. Patients receiving intravenous paracetamol also had a small reduction in postoperative opioid requirements, but the time at which rescue analgesia was required did not differ. These results suggest that intravenous paracetamol may offer a small advantage over oral paracetamol premedication at providing postoperative analgesia.

Perioperative anesthesia. Features of anesthesia for patients with different surgeries and traumas

Background. Chronic postoperative and post-traumatic pain is included in the new edition of the International Classification of Diseases, which should become valid on 01.01.2022. Routine adherence to specialized differentiated evidence-based protocols for perioperative management of patients is the best way to optimize perioperative analgesia. The patient and his relatives should be informed about the possibility of postoperative pain (POP) and treatment options. It is advisable to use multimodal analgesia (MMA) with non-pharmacological methods to eliminate POP.&#x0D; Objective. To describe modern points of view on perioperative analgesia.&#x0D; Materials and methods. Analysis of literature data on this topic.&#x0D; Results and discussion. Analgesics are divided into antinociceptive drugs (hyperalgetics (morphine and μ-agonists) and antihyperalgetics – paracetamol, nonsteroidal anti-inflammatory drugs (NSAID), glucocorticoids, nefopam, tramadol) and non-antinociceptive antihyperalgetics (ketamine, gabapentine, topical anesthetics, clonidine, adenosine, neostigmine). Whenever possible, every anesthesiologist should take a multimodal approach. In the absence of contraindications, all patients should receive NSAID around the clock, including cyclooxygenase-2 inhibitors or acetaminophen (paracetamol). Intravenous paracetamol has a number of advantages over oral one. With the infusion of paracetamol (Infulgan, “Yuria-Pharm”), the time to achieve clinically significant analgesia is only 8 minutes, and to achieve maximum anesthesia – 15 minutes. Preoperative intravenous paracetamol has convincingly demonstrated an opioid-sparing effect in various surgical interventions (joint replacement, bariatric surgery, surgery for head and neck tumors) and delivery. The financial and economic feasibility of treatment with intravenous paracetamol has been proven. Additionally, the administration of regional blockades with topical anesthetics should be considered. It is also advisable to use pregabalin or gabapentin. The choice of drug, dose, route of administration and duration of therapy should be individualized. Intramuscular administration of analgesics should be avoided. In neuropathic POP, first-line drugs include tricyclic antidepressants, norepinephrine and serotonin reuptake inhibitors, antiepileptics, topical anesthetics (bupivacaine – Longocaine, “Yuria-Pharm”), second-line – opioids, tramadol, and third-line – mexiletine, NMDA-receptor antagonists, capsaicin. It should be noted that bupivacaine is 2-3 times more effective than lidocaine and 6-12 times more effective than novocaine. Local anesthetics can be used for infiltration anesthesia, blockade, intraperitoneal injection and direct infusion into the wound. Dexmedetomidine, which also provides sedation and additional analgesia, can be used to prolong sensory and motor anesthesia with bupivacaine. Analgesia in different interventions is slightly different. Thus, in total joint arthroplasty, a single blockade of the adductor canal is effective. When restoring the rotator cuff, it is advisable to use an arthroscopic approach, paracetamol (Infulgan), NSAID, dexamethasone and regional anesthesia. In spinal surgery, postoperative MMA involves the use of cold compresses, pregabalin, cyclobenzaprine, tramadol, if necessary – oxycodone. In total mastectomy, gabapentin and paracetamol should be prescribed before surgery, and opioids, ondansetron, and/or lorazepam on demand – after surgery. After abdominal hysterectomy, in severe pain opioids are used in combination with cyclooxygenase-2 inhibitors or non-selective NSAID, in mild pain – cyclooxygenase-2 inhibitors or non-selective NSAID in combination with paracetamol and, if necessary, weak opioids. Postoperative management of women after caesarean section involves the use of oral NSAID and paracetamol, opioids (rescue analgesia) and long-term infusions of local anesthetics into the wound.&#x0D; Conclusions. 1. Anesthesia plays a leading role in accelerated postoperative rehabilitation programs. 2. When choosing an approach to analgesia one should take into account the area of intervention. 3. Rational reduction in the opioids amount is achieved through balanced MMA. 4. The most basic components of MMA include NSAID, paracetamol and regional techniques.

Analgesia in the intensive care unit

Background. Sedation is a technique of using drugs to put a patient in a condition in which he can tolerate unpleasant procedures, while maintaining cardiorespiratory function. The main problems associated with analgesia and sedation (AS) are associated with the development of hypoxia, vomiting and aspiration, hypotension and hemodynamic instability, apnea.&#x0D; Objective. To describe the features of the modern AS.&#x0D; Materials and methods. Analysis of literature data on this issue.&#x0D; Results and discussion. AS can be performed with the help of different drugs. Benzodiazepines (preferably midazolam) and/or propofol in combination with low doses of opioids should be used in patients with concomitant cardiac abnormalities. The use of propofol in this category of patients is carried out by fractional administration (on average, 50 mg) with an interval of 30-40 seconds until an adequate sedative effect is achieved. Dexmedetomidine has been suggested as an adjuvant. It should be kept in mind that benzodiazepines are not suitable for creating a long-lasting sedative effect, and can cause paradoxical agitation in the elderly. Features of sedation in patients at risk of obstructive sleep apnea syndrome are represented with the use of a minimum dose of hypnotics without the use of opioids. Dexmedetomidine is considered as an alternative. It is advisable to use continuous positive airways pressure by inhalation of oxygen through the nasal cannula. Patients with morbid obesity should avoid lying on their back. For the effective control of airway patency, it is advisable to use endotracheal intubation. It is recommended to avoid long-acting drugs and drugs that cause respiratory depression. The use of propofol in this group is often associated with respiratory complications, so the use of remifentanil and dexmedetomidine is recommended as an alternative. For patients with chronic renal failure, midazolam and/or fentanyl should be preferred, however, the cardiovascular and pulmonary side effects of any of these drugs are exacerbated when they are used concomitantly. In patients with hepatic dysfunction, midazolam may exacerbate symptoms, so propofol should be preferred. If the latter is used, the doctor should be near the patient throughout the procedure and monitor him exclusively. As for dexmedetomidine, this drug selectively binds and activates presynaptic α2-adrenoreceptors, inhibiting the release of norepinephrine. As a result, postsynaptic activation of adrenoceptors is inhibited, sympathetic activity is suppressed, leading to analgesia, sedation and decrease of anxiety. Under conditions of mild or moderate sedation caused by dexmedetomidine, patients respond to verbal stimulation and are able to communicate and cooperate with medical staff, and after awakening show high results in tests of central nervous system activity. Dexmedetomidine is less likely to cause postoperative delirium than midazolam (54 % vs. 76.6 %) and does not adversely affect sleep quality, unlike propofol. Dexmedetomidine can be used together with paracetamol. Intravenous paracetamol significantly reduces postoperative pain and the need for opioids.&#x0D; Conclusions. 1. AS can be performed with the use of benzodiazepines, propofol, dexmedetomidine. 2. Benzodiazepines are not suitable for creating a long-lasting sedative effect, and can cause paradoxical agitation in the elderly. 3. Patients with different comorbid conditions are characterized by different features of required AS. 4. Dexmedetomidine gives the patient the opportunity to communicate and cooperate with medical staff, rarely causes postoperative delirium and does not adversely affect the sleep quality. 5. Intravenous paracetamol significantly reduces postoperative pain and the need for opioids.

Role of intravenous paracetamol as an adjunct to epidural analgesia in immediate postoperative period in abdominal cancer surgeries

Aims and Objectives: To evaluate analgesic efficacy and side effects of intravenous paracetamol, also assess IV-PCA morphine consumption in patients undertaken abdominal cancer surgery. Materials and Methods: Total 160 ASA grade I and II patients of both the sex, between age 18-70 years were randomly divided in two equal groups to receive either IV paracetamol 1gm or no paracetamol after surgery. Hemodynamic parameters, pain intensity scores, amount of morphine consumption and side effects were recorded. Results: The control group had higher mean heart rate, mean arterial blood pressures, mean respiratory rate than paracetamol group. Pain intensity score was much higher in control group at any time which needed considerably higher dose of rescue analgesic (IV morphine) for pain control than paracetamol group. We found no significant difference statistically in sedation scores in patients using patient controlled analgesia in either group. Side effects were found to be lower in paracetamol group compared to control group but difference was not significant statistically. Conclusion: Paracetamol is safe and effective drug for postoperative analgesia with negligible side effects. Keywords: IV paracetamol, IV-PCA morphine, Abdominal cancer surgery, Epidural Analgesia, Pain scores, Sedation score.

To compare intravenous paracetamol with tramadol given pre-emptively for intraoperative and postoperative analgesia- A randomized controlled trial

Introduction: The recommended approach for postoperative pain management is to initiate the treatment with analgesics such as paracetamol, NSAIDS, and aspirin followed by adjunctive use of opioids to treat more acute pain symptoms. However, the adverse effects associated with opioids and NSAIDS are well established. Aim: To study the efficacy of paracetamol in comparison to Tramadol when used as analgesic component of balanced anesthesia, pre-emptively for intraoperative and postoperative purpose. To study their side effects. To find out which of these two drugs is better in providing intraoperative and postoperative analgesia with minimum side effects. Materials and Methods: 60 patients of either sex, divided using computer generated random number table into 2 equal groups. Group T: (n 30): Tramadol hydrochloride group, Group P: (n 30): Paracetamol group. The dose of paracetamol and tramadol hydrochloride was 15mg/kg and 2mg/ kg body weight respectively. Statistical analysis: analysis was done by SPSS software version 11 by using Z test, chi-square test, proportion test (Z). P value less than 0.05 was considered as significant and less than 0.0001 as highly significant. Results: Both the groups were comparable with respect to their demographic profile, ASA status, and surgical procedures. Both paracetamol and tramadol have a good analgesic action and fewer side effects. The mean score of VAS Scale in group P (1.86 i‚± 2.40) and group T (3.03 i‚± 2.42) was similar and difference was not statistically significant. Also the side effects were comparable in both groups. Total number of rescue analgesics required by the group P (1.6) was significantly less as compared to the group T (3.7) with Z value = 4.00, p < 0.0001. Conclusion: Paracetamol has a better efficacy than tramadol hydrochloride in providing intra-operative and post-operative analgesia, when used pre-emptively with reduced number of doses of analgesic and almost no side effects. Keywords: Analgesi