Iv Paracetamol Research Articles

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study.

This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25mg pethidine as a rescue analgesic to patients with VAS ≥4. Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

Comparison of Single-Injection and Multiple-Injection Thoracic Paravertebral Block in Preventing Pain after Video-Assisted Thoracoscopic Surgery

Aim: In our study, we aimed to compare the effect of single and multiple thoracic paravertebral block (TPVB) patients who underwent video asisted thoracoscopic surgery (VATS) on hemodynamic parameters, postoperative visual analog scale (VAS) and sedation scores, and total analgesic consumption. Materials and Method: The ASA II-III, age between 18 to 65 years, and body mass index lower than thirty, 60 patients who underwent elective VATS were included to this study. Patients were divided into two groups as single (Group S), (n:30) and multiple (Group M), (n:30) TPVB. Block was performed at T6 level in Group S and at T4, T6, T8 levels in Group M by using 21 mL 0.5 % bupivacaine. Intravenous patient controlled analgesia (PCA) was performed for both groups after surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), Ramsay sedation score (RSS), tramadol consumption during 24 hours, resting and coughing VAS scores were recorded before PCA and at 30th, first, second, 6th, 12th, 20th, and 24th hours of postoperative periods. 50 mg iv dexketoprophene was administered when coughing VAS score above the 4. Despite the iv dexketoprophene, in case of consistent pain 1 gr iv paracetamol was given to the patients, and all additional analgesic requirement was recorded. Results: Hemodynamic parameters were similar in both groups during postoperative period (p>0.05). VAS scores were higher in Group M but there were not statistically significant (p>0.05). Additional analgesic requirement was significantly higher in Group M, (p>0.04). Cumulative tramadol consumption was comparable between the groups, (p>0.05). Conclusion: In TPVB, it was observed that single and multiple injections provided similar postoperative pain scores and postoperative cumulative tramadol consumption, but we observed a high additional analgesic requirement in multiple injection group. Based on this result, we concluded that there would be no need to disturb patient comfort and prolong the procedure by applying multiple injections.

Comparison of Single-Injection and Multiple-Injection Thoracic Paravertebral Block in Preventing Pain after Video-Assisted Thoracoscopic Surgery

Aim: In our study, we aimed to compare the effect of single and multiple thoracic paravertebral block (TPVB) patients who underwent video assisted thoracoscopic surgery (VATS) on hemodynamic parameters, postoperative visual analog scale (VAS) and sedation scores, and total analgesic consumption. Materials and Method: The ASA II-III, age between 18 to 65 years, and body mass index lower than thirty, 60 patients who underwent elective VATS were included to this study. Patients were divided into two groups as single (Group S), (n:30) and multiple (Group M), (n:30) TPVB. Block was performed at T6 level in Group S and at T4, T6, T8 levels in Group M by using 21 mL 0.5 % bupivacaine. Intravenous patient-controlled analgesia (PCA) was performed for both groups after surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), Ramsay sedation score (RSS), tramadol consumption during 24 hours, resting and coughing VAS scores were recorded before PCA and at 30th, first, second, 6th, 12th, 20th, and 24th hours of postoperative periods. 50 mg iv dexketoprophene was administered when coughing VAS score above the 4. Despite the iv dexketoprophene, in case of consistent pain 1 gr iv paracetamol was given to the patients, and all additional analgesic requirement was recorded. Results: Hemodynamic parameters were similar in both groups during postoperative period (p>0.05). VAS scores were higher in Group M but there were not statistically significant (p>0.05). Additional analgesic requirement was significantly higher in Group M, (p>0.04). Cumulative tramadol consumption was comparable between the groups, (p>0.05). Conclusion: In TPVB, it was observed that single and multiple injections provided similar postoperative pain scores and postoperative cumulative tramadol consumption, but we observed a high additional analgesic requirement in multiple injection group. Based on this result, we concluded that there would be no need to disturb patient comfort and prolong the procedure by applying multiple injections.

Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6.

Background and objectiveClinical studies on COVID-19 headache are limited. This prospective study aimed to define headache characteristics, associated clinical and laboratory factors, and treatment response in COVID-19.MethodsCross-sectional study enrolled 287 patients diagnosed with COVID-19 and hospitalized on a regular ward during the pandemic. All patients were examined face to face and followed by a neurologist during their stay in the hospital. The characteristics, concomitant symptoms, treatment responses, and laboratory findings of COVID-19-associated headaches were recorded.ResultsEighty-three COVID-19 patients reported headache (28.9%), in which 85.5% had no prior headaches. Mean age was 48.40 ± 15.90 and 58% was men. Compared to COVID-19 patients without headache (n = 204), patients with headache showed significantly higher frequency of pulmonary involvement (76%) and increased D-dimer levels. Fifty-nine percent of headaches responded iv paracetamol 1000 mg, and 85% of the paracetamol unresponsive headaches were relieved by greater occipital nerve (GON) blocks. Latent class cluster analysis identified 2 distinct class of bilateral, frontal, throbbing headaches: severe (VAS > 84), longer (> 14 h), frequent (> 7 headache days), paracetamol unresponsive-GON responsive headaches (85%), with pulmonary involvement (100%), and higher IL-6 levels (> 90 pg/mL) were classified in cluster 1. Cluster 2 included moderately affected patients (VAS > 54, > 6 h, > 4 days, 60% pulmonary involvement, > 20 pg/mL IL-6) and paracetamol responsive headaches (96%). VAS scores showed positive linear correlation with IL-6 levels (p < 0.001; r = 0.567).ConclusionThe intensity, duration, frequency, bilateral frontal location, and treatment response of COVID-19 headache was related to pulmonary involvement and IL-6 levels, which indicated a role of inflammation in determining the headache manifestations in moderately affected hospitalized patients. ROC curve cutoff values pointed that VAS > 70 severity, > 9 h duration, > 5 headache days, and IL-6 > 43 pg/mL levels can be diagnostic for COVID-19 headache. GON blocks can effectively abort headache when patients are unresponsive to paracetamol, and other NSAIDs are avoided during the SARS-CoV-2 infection.

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.

P206 EVALUATION OF PREEMPTIVE MULTIMODAL ANALGESIA IN IVOR LEWIS ESOPHAGECTOMY

Abstract Aim of the study is the evaluation of preemptive multimodal analgesia vs established technique of single epidural, in Ivor Lewis esophagectomy, perioperatively. Background &amp; Methods In a randomized prospective trial, 25 patients were randomly assigned to two groups (A=12: preemptive multimodal analgesia, and B=13: epidural analgesia) after informed consent. Patients with coagulative disorders, and renal or hepatic impairment were excluded from study. In all patients a thoracic epidural (T5 – T7) was placed before anesthesia induction. Anesthetic protocol was the same, according body weight, in both groups, apart from analgesic drugs. Group A patients received morphine 1.5-3mg and ropivacaine 0.25% 10-12 ml epidurally (ed), and paracetamol 1gr, parecoxib 40mg, clonidine 150mcg, dexamethasone 8mg, lidocaine 1mg/kg, and magnesium sulfate 25% 10 ml iv, at least 20 min before surgical incision, while in group B same doses of ed morphine and ropivacaine were administered post-incision and iv paracetamol and parecoxib were administered 1hr before end of surgery. Surgical incision infiltration in both wounds with ropivacaine 0.375% 20ml was performed jn both groups’ patients. Intraoperative opioid doses were titrated accordingly. Analgesic needs intra- and postoperatively, as well as vital signs stability and side effects such as postoperative nausea or vomiting (PONV), dizziness, sleepiness, and respiratory suppression were recorded. Results Group A patients received significantly lower opioid doses intraoperatively (p&lt;0.001), 2 (17%) of them did not need extra opioids at all, and in 8 (67%), operation was completed with only one low dose of fentanyl (2-3mcg/kg) before abdominal surgical incision. Group A patients had stable heart rate (HR) and blood pressure (BP) during whole operation, while 11 (84.6%) from group B (p&lt;0.001) demonstrated HR and BP raising in certain surgical times. All both groups’ patients were transferred to ICU awake. 5 (38.46%) group B patients (p&gt;0.005) required rescue amalgesic post-awakening. None of both groups’patients demonstrated any drugs’ side effects. Conclusion Preemptive multimodal analgesia seems to be more efficient, reducing needs for opioids intraoperatively, rescue analgesics postoperatively and providing better hemodynamic stability, than single epidural. Further studies are needed to support this conclusion.

Role of Intravenous Paracetamol as Pre-Emptive Analgesic for Laparoscopic Cholecystectomy

Background: Despite the high level of awareness about the importance of post-operative pain management, lot of investigations and study results show an unacceptable high rate of incidence of pain after surgery. Pre- emptive pain control is regional or systemic analgesics, applied before starting the surgical procedure. The effect is achieved by suppressing, central or peripheral nociceptors, either together or separately by sensitization. We studied the effect of intravenous Paracetamol as pre-emptive analgesic in patients undergoing laparoscopic cholecystectomy.&#x0D; Method: A total number of 60 adult patient with ASA physical status I &amp; II scheduled for Laparoscopic cholecystectomy under general anaesthesia were randomly enrolled in this study. Patients were randomly allocacated equally into two groups A and B according to computerized random table, 30 in each group. Patients of Group A (n=30) received I.V Paracetamol 10mg/kg(100ml) 10 min before skin incision and Group B (n=30) received 100 ml of Normal saline 10 min before skin incision. It was a single blind, randomized, prospective, case-control study. Observation and management of pain, nausea, vomiting, respiratory depression, allergic reaction, amount of opioid requirement and time of analgesic demand after operation were carried out in data collection sheet.&#x0D; Result: The total dose of postoperative opioid needed in Group-A was significantly lower than that in the Group- B(p=0.012). The pain scores were comparatively low in case of group-A than that in Group-B from beginning to 24 hours of evaluation following operation(p=0.027). About one-third (32%) of the patient in each group experienced nausea at 1 hour interval post operatively. However, the complaint of nausea at 6 and 12 hours was much less in the Group-A than that in the Group-B. Vomiting was negligible in either group. Majority (80%) of patient in Group-B demanded analgesic (pethedine) 10 minutes earlier after operation as opposed to only 8% of patients in Group-A (p&lt;0.001). No other side effects were recorded in either of the groups.&#x0D; Conclusion: Our findings indicate that pre-emptive administration of iv Paracetamol (10mg/kg) in patients undergoing Laparoscopic Cholecystectomy ensures an effective postoperative analgesia, increases the time to first analgesic requirement and reduces opioid consumption.&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 159-163

Effect of preoperative application of buprenorphine transdermal patch on analgesic requirement in postoperative period in hip and knee replacement surgeries.

Background and Aims:Although no pain control following hip and knee replacement surgeries has attained gold standard, it is clear that patients should have optimum pain control after total knee arthroplasty and total hip arthroplasty for enhanced satisfaction and function. We conducted this study to evaluate the effect of preoperative application of buprenorphine transdermal patch on analgesic requirement in perioperative period after knee and hip replacement surgeriesMaterial and Methods:Following institutional ethical committee approval and written informed consent, a prospective study was conducted in 50 patients of either gender belonging to ASA1 or ASA2 status, requiring either knee or hip replacement. The patients were assessed in preoperative period, and buprenorphine patch of 10 mg (sustained release of 10 μg/h) was applied either on the chest or on outer side of the arm 12 h before surgery. Total knee arthroplasty/total hip arthroplasty was done under combined spinal epidural blockade. Epidural infusion with 0.125% bupivacaine at a rate of 4–5 mL/h was continued in postoperative period. Intravenous opioid analgesics were avoided in postoperative period, and whenever required only iv paracetamol 1g was given. Outcome in terms of requirement of iv analgesic, visual analog pain score, any associated nausea vomiting, itching, and level of somnolence was noted in postoperative period at 1,2,3,4,8,12,16,20,24,48, and 72 h, respectively.Results:None of the patient required rescue analgesia in the first 2 h. During 72 h postoperative period of observation 32% of patients demanded rescue analgesics at 8th hour, followed by 20% at 4th hour and 16% at 12th hour.Conclusion:Preoperative application of transdermal patch significantly reduces the requirement of postoperative intravenous opioid and nonopioid analgesic drugs.

Use of intravenous paracetamol for patent ductus arteriosus closure in preterm and very low birth infants

The patent ductus arteriosus contributes to common morbidities in premature infants.Ductal closure may require pharmocological management and/or surgical ligation up to 70% of time in extremely low birth infants. Ductal closure utilising NSAIDs has many adverse effects related to their vasoconstrictive effects on renal cerebral and mesentric vessels. While NSAIDS are known to inhibit COX activity via Arachidonic acid pathway, acetaminophen inhibits peroxidase activity. It seems to be a reasonable optionto consider for PDA closure, especially in those infants for which NSAIDSmay be contraindicated. Place of study: A prospective study in Neonatal intensive care unit 1. Maternity and childrens hospital. Makkah. Patients: preterms and extreme preterms-24–30 weeks, Birth weight 450 g-1.2 Kg with haemodynamically significant PDA. iNTERVENTION: iv PARACETAMOL −15 MG/kG/dose Q 6 hrly × 3–5 days with parenteal consent. 1. Total no: of admissions in NICU-1 1150. For 20 months from 8/1437 to 3/39. 2. 100 patients had haemodynamically significant PDA where NSAIDs were contraindicated. 3 24-26 wks 20 27–29 wks 50 30–32 wks 30 4. weight wise distribution. <1 kg 1–1.5 Kg 1.5–2 kg. 45 52 3 5 male: female. M 53 F 47 1. −32% had PNA. 2–13% had CPR at birth. 3 −40% had IVH of which 11% had gradeIII-iv IVH. 4. −35% had pulmonary haemorrhage. 5 −13% had pneumothorax. 6. −61% had CLD. 7. −86% had hypotension 8. – 100% were NPO. 9. All had central line. 10. 90% had renal impairment. 11–95% had electrolyte imbalance either before or after treatment. 12 49% had +ve blood culture. 13. thrombocytopenia was noticed in 50% of them. 14 80% were discharged home 20% expired. PDA: echo first done: 1–7 days. 80% 2nd/3rd day. Duration of paracetamol: 3–5 days. Effective closure after 1st dose-44%. Effective closure after 2nd course of paracetamol-21%. NSAIDS used after paracetamol in 10%. Hydrochlorthiazide used in 8%. PDA reopened due to sepsis-7%. Intravenous paracetamol can be safely used in extreme low birth infants.

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

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.&#x0D; Objective: The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous (iv) paracetamol in MRM.&#x0D; 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.&#x0D; 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 &lt; 0.05) until 24 after surgery.&#x0D; Conclusion: Pre-emptive iv paracetamol in comparison to intra- operative paracetamol, provided effective and reliable post- operative analgesia after modified radical mastectomy.

Efficacy of Paracetamol Versus Tramadol Plus Ketorolac for Pain Control after Hemorrhoidectomy: A Prospective Randomized Trial

nbsp nbsp nbsp Objectives Postoperative pain after hemorrhoidectomy is the most feared complication that may result in severe patient discomfort and in a delayed return to daily activities nbsp nbsp nbsp Methods In a prospective randomized controlled clinical trial consecutive patients pts with grades III and IV hemorrhoids were enrolled All pts who underwent conventional Milligan Morgan hemorrhoidectomy were randomly assigned to receive either mg intravenous iv paracetamol infusion times daily group I pts or iv constant infusion pump of tramadol plus ketorolac group II patients Pain was evaluated using a visual analogue scale VAS at and h postoperatively Length of hospital stay and severe complications were recorded nbsp nbsp nbsp Results The two groups were homogeneous with respect to sex age and degree of hemorrhoidal disease No pain was recorded after h in both groups due to persistence of the analgesic effect of the spinal anesthesia Group II had a significant reduction in VAS scores at h compared to group I p lt At h pts in group II vs pts in group I were discharged p There were two cases of bleeding requiring surgery in group I nbsp nbsp nbsp Conclusion Pain after hemorrhoidectomy is more likely to be controlled by constant infusion pump of tramadol plus ketorolac than by interspersed infusion of paracetamol A better pain control is associated with a shorter hospital stay nbsp

Effect of intravenous vitamin C on postoperative pain in uvulopalatopharyngoplasty with tonsillectomy.

Postoperative pain is a common problem in hospitals. Adults undergoing uvulopalatopharyngoplasty (UPPP) with tonsillectomy experience an unacceptable level of intense postoperative pain, especially during the first 24 h after surgery. This study investigated the analgesic effects of vitamin C in patients undergoing UPPP and tonsillectomy. This study was done on forty patients that were evaluated in a randomised double-blinded clinical trial. Patients included in the study were within the age range of 25-50 years with BMI<35, physical status I,II according to the American Society of Anesthesia (ASA) and who underwent uvulopalatopharyngoplasty and tonsillectomy. Patients with epilepsy, BMI>35, any neuropsychiatric disorders, a history of chronic pain, liver and/or renal disease, drug allergy, and drug abuse were excluded from the study. All patients underwent the same method of anaesthesia and surgical procedure. During the first 30 min after the beginning of the surgery, group C (vitamin C) received infusion of 3 g vitamin C in 500 mL of Ringer and group P received 6 mL normal saline in 500 mL of Ringer. Measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate were recorded before and during anaesthesia and at intervals of 0,15,30 and 60 min after extubation. Pain severity was recorded according to VAS score at intervals of 0 (recovery room), 6, 12 and 24 h after the procedure, request for analgesic drugs (iv paracetamol or pethedine) according to total number of times of analgesic request and time of the first dose of analgesic use and dose of pethidine were also recorded by questionnaire. There was a significant difference in evaluations for mean pain severity between the two groups at recovery room, 6, 12 and 24 h after surgery (P-value = 0.001). There was a significant difference in mean times that patient requested an analgesic, time of first dose of analgesic and pethidine dose between the two groups (P-value< 0.05). There was no significant differences in measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate in different times between the two groups (P-value> 0.05). Blood loss was similar in the two groups (P-value> 0.05). According to this study, administration of vitamin C 3 g IV intraoperative reduced postoperative pain without increased side-effects in patients undergoing UPPP and tonsillectomy.

UNINTENTIONAL OVERDOSING OF INTRAVENOUS PARACETAMOL IN NEONATES: WHERE IS THE TOXICITY?

IntroductionParacetamol is a readily available antipyretic and analgesic, widely used to treat mild to moderate pain. Unintentional overdosing in neonates occurs, but so far only single case reports have been published. Based on an own case and a bibliographic search, we review the safety and tolerance of unintentiontal overdosing of intravenous paracetamol in neonates.Material and methodsA bibliographic search in PubMed and EMBASE using key words: “Pharmacokinetics paracetamol neonate”, “Metabolism paracetamol neonate” and “Effects paracetamol neonate” was performed.ResultsThirty cases of neonatal iv paracetamol intoxication were reported. Overall, the reported number remains limited, but even 10-fold drug errors only rarely result in significant morbidity or mortality. In accidental overdosing only one case of relevant hepatic toxicity has been reported.ConclusionThe reported cases of unintentional paracetamol overdosing in neonates suggests a good safety profile and a population specific tolerance. Acetylcysteine administration is recommended, but the prognosis seems to be better in neonates.

Pain Treatment of Newborns: Paracetamol Rectal Versus Intravenous Administration, A Randomised Open Clinical Trial

Background and aim: Early recognition and treatment of pain is of great importance in the neonatal period. Paracetamol is the most frequent prescribed medicine for pain treatment. Administration of rectal paracetamol has limitations and the effectiveness can be variable in neonates. This study is based on the hypothesis that intravenous (iv) paracetamol is well tolerated, less variable and therefore more reliable in preterm neonates compared to rectal paracetamol. We therefore compared the effectiveness of intravenous and rectal administration in (preterm) neonates during a period of sickness accompanied by pain. Methods: We included 21 neonates with pain, post menstrual age (PMA) of 28-44 weeks. They received paracetamol rectal or intravenous according to Dutch guidelines. Serum concentrations at steady state (t = 0, 0.5, 1, 2, 4, 6 hours) were determined. Results: Clearance was dependent of weight, not of PMA. Estimated mean serum concentrations after four administrations were 4,8 ± 0,7, 8,1 ± 1,9 and 10,2 ± 3,1 mg/L and after rectal administration 4,1 (n=1), 12,6 ± 6,0 and 14,0 ± 6,7 mg/L. Hepato- or renal dysfunction were not observed. Conclusion: Rectal and intravenous administration of paracetamol is well tolerated in (preterm) neonates. Rectal administration gives no paracetamol absorption or a major variation with inter- and intra-individual variation, which turns out to be unreliable especially in (pre)term neonates. Dosing of paracetamol (rectal and iv) should be based on weight instead of PMA. Further research is needed to define the exact dosing regime and target concentration of intravenous paracetamol in (preterm) neonates in comparison to the pain experience especially in preterm neonates.

A Study on Pre-Emptive Analgesic Effect of Intravenous Paracetamol in Functional Endoscopic Sinus Surgeries: A Randomized, Double-Blinded Clinical Study

Functional Endoscopic Sinus Surgery (FESS) is associated with significant post-operative pain. Intravenous (iv) paracetamol provides pain relief in most patients who have undergone FESS. In some studies, it was found to be inadequate. 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 FESS. The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous (iv) paracetamol in FESS. Following institutional ethics committee approval, thirty nine 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. 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. Pre-emptive iv paracetamol in comparison to intra-operative paracetamol, provided effective and reliable post-operative analgesia after FESS.

Intravenous paracetamol infusion: Superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery.

Background:Paracetamol; a cyclooxygenase inhibitor; acts through the central nervous system as well as serotoninergic system as a nonopioid analgesic. A prospective, double-blinded, and randomized-controlled study was carried out to compare the efficacy of preoperative 1g intravenous (iv) paracetamol with placebo in providing postoperative analgesia in head-neck cancer surgery.Materials and Methods:From 2008 February to 2009 December, 80 patients for palliative head-neck cancer surgery were randomly divided into (F) and (P) Group receiving ivplacebo and iv paracetamol, respectively, 5 min before induction. Everybody received fentanyl before induction and IM diclofenac for pain relief at8 hourly for 24 h after surgery. Visual analogue scale (VAS) and amount of fentanyl were measured for postoperative pain assessment (24 h).Results and Statistical analysis:The mean VAS score in 1st, 2nd postoperative hour, and fentanyl requirement was less and the need for rescue analgesic was delayed in ivparacetamol group which were all statistically significant. Paracetamol group had a shorter surgical intensive care unit (SICU) and hospital stay which was also statistically significant.Conclusion:The study demonstrates the effectiveness of ivparacetamol as preemptive analgesic in the postoperative pain control after head-neck cancer surgery and earlier discharge from hospital.

Efficacy of intravenous dexketoprofen trometamol compared to intravenous paracetamol for postoperative pain management after day-case operative hysteroscopy: randomized, double-blind, placebo-controlled study

Adequate pain management following day-case surgery allows early ambulation of patients. In this study, we aimed to compare postoperative analgesic efficacy of intravenous (iv) dexketoprofen vs. iv paracetamol following day-case operative hysteroscopy. One hundred and fourteen American Society of Anesthesiologists (ASA) I-II patients scheduled for day-case operative hysteroscopy were recruited and randomized to three groups in the study. Group D received 50 mg iv dexketoprofen trometamol, Group P 1000 mg iv paracetamol and Group C normal saline solution. Visual Analogue Scale (VAS) pain intensity, pain relief, sedation, nausea-vomiting, other side effects, and additional opioid analgesic requirement were noted at postoperative 15 minutes (min), 30 min, 1 hour (h), 2 h, and 3 h. Patients with VAS>=40 mm received meperidine 0.25 mg/kg as rescue analgesic medication. VAS scores at 15 min, 30 min, 1 h, and 2 h were significantly lower in Group D compared to Group C. VAS scores at 15 min and 30 min were significantly lower in Group D compared to Group P. The percentages of patients who required opioid treatment were 34%, 60%, and 63% in Groups D, P and C, respectively (p<0.05). Total delivered opioid dose was 0.10±0.16 mg/kg, 027±0.33 mg/kg and 0.28±0.25 mg/kg in Groups D, P and C, respectively (p<0.05). Pain relief score was significantly better in Group D at postoperative 15 min when compared with Group C (p<0.05). Our study demonstrated that iv dexketoprofen has superior efficacy for postoperative pain management following day-case operative hysteroscopy when compared with paracetamol and placebo.

Preventive Analgesia with Intravenous Paracetamol for Post-cesarean section Pain Control

Objectives: Effective pain therapy after cesarean section is essential for parturient comfort and to allow early ambulation to facilitate care of her infant. This study evaluated the analgesic effect of preventive 1gr intravenous paracetamol on postoperative pain and analgesic consumption during the 24 hours after cesarean section. Materials and Methods: One-hundred American Society of Anesthesiologists (ASA) I or II status parturient scheduled for elective cesarean section under spinal anesthesia. Patients received 1gr iv paracetamol into 100 ml normal saline (study group; n=50) or normal saline alone (placebo group; n=50) 20 minutes before the end of operation. Results: Pain scores were lower in the study group in the Post anesthesia care unit (PACU) (p<0.001) and up to 4h after operation (p<0.001). Cumulative analgesic consumption was lower in the study group (p<0.001). Conclusion: Preventive administration of 1gr iv paracetamol reduces the intensity of pain in the PACU and until 4h after operation and analgesic consumption following cesarean section.

PTU-111 A Prospective Study of Intravenous Paracetamol Prescribing and its use in Patients at Risk of Iatrogenic Paracetamol Induced Hepatotoxicity

IntroductionIntravenous (iv) paracetamol can cause severe hepatotoxicity and lead to death if inappropriately prescribed1. It is increasingly being used for post-operative pain and pyrexia2. There is a lack of awareness...

Clinical pharmacology of intravenous paracetamol in perinatal medicine

Clinical pharmacology aims to predict drug-related effects based on compound and population specific pharmacokinetics (PK, concentration-time), and pharmacodynamics (PD, concentration-effect). Consequently, dosing needs to be based on the physiological characteristics of the individual patient. Pregnancy and early infancy hereby warrant focused assessment. The specific characteristics of both subpopulations will be illustrated based on observations on intravenous (iv ) paracetamol PK and PD collected in these specific populations. At delivery, there is a significant higher paracetamol clearance (+ 45%, L/h) when compared to non-pregnant observations. This higher clearance is in part explained by a proportional increase in oxidative metabolite production, but mainly an increase in glucuronidation. When focusing on PD, an association between maternal paracetamol exposure and atopy in infancy and fetal gastroshizis has been reported. In early infancy, paracetamol clearance is significantly lower and mainly depends on size (weight 0.75), while also the distribution volume is higher (L/kg). Reports on hepatic tolerance, haemodynamic stability and impact of body temperature have been published while the concentration effect profile for analgesia seems to be similar between neonates and children. Similar to maternal exposure, there are reports on the association with atopy. Studies on the use of paracetamol to close the patent ductus arteriosus are ongoing. At least, these observations provide evidence on the need to study commonly administered anesthetics in such specific subpopulations with specific focus on both population specific PK and PD to further improve patient tailored pharmacotherapy.