Combination Of Paracetamol Research Articles

Pain management with paracetamol and ibuprofen in combination

Introduction: Pain is not limited to the activation of nociceptors but it is also influenced by psychological and physical factors through imbalance between inhibitory and stimulatory pathways. Methods: Medical literature about the physiopathology and treatment of pain, with a particular focus on mechanical and inflammatory musculoskeletal pain, was reviewed and combined with the expert opinion of the author. Results: Analgesic therapy that combines drugs with different mechanisms of action can increase the efficacy while de- creasing the side effects. Several studies have shown that the combination of paracetamol and ibuprofen (resulting in a cen- tral analgesic and a peripheral anti-inflammatory action) provides superior efficacy and better safety profile than separate drugs. In 2019 a board of experts recommended this combination as the most suitable in treating mild-moderate musculo- skeletal pain. Paracetamol/Ibuprofen combination is also indicated in musculoskeletal inflammatory pain associated and worsened by muscle contraction, like low back pain, chronic joint pain, osteoarthritis, tendinopathy due to rotator cuff syndrome; the combination is able to counteract both the inflammatory process and the descending stimulatory pathway. Conclusions: The combination of paracetamol and ibuprofen shows efficacy and tolerability in different types of pain and is indicated as a first-line analgesic treatment in various morbid conditions. Keywords: Pain treatment, musculoskeletal pain, ibuprofen, paracetamol

Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.

Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.

Intravenous acetaminophen with morphine versus intravenous morphine alone for acute pain in the emergency room: protocol for a multicenter, randomized, placebo-controlled, double-blinded study (ADAMOPA)

BackgroundIn emergency medicine, pain is a frequent reason for consultation. However, there is a great variation in its management which is often insufficient. The use intravenous morphine alone or multimodal analgesia with paracetamol is recommended for severe pain. But robust data are lacking to justify the association of paracetamol with morphine versus morphine alone for pain management in the emergency room (ER). The aim of our study is therefore to assess if in patients with acute pain of moderate to severe intensity with a numerical verbal scale (NVS) ≥5 in the ER, the intravenous administration of morphine alone is not inferior to the administration of intravenous morphine combined with paracetamol at 30 min from the first administration of the study drug.MethodsADAMOPA is a prospective, non-inferiority, multicenter, placebo-controlled, parallel-group, randomized (1:1), double-blind trial. Subjects will be enrolled in the ER if they experience moderate to severe, acute, non-traumatic, and traumatic pain, defined as an NVS ≥5. The primary endpoint will be the between-group difference in mean change in NVS pain scores among patients receiving the combination of intravenous morphine plus paracetamol or intravenous morphine given alone, measured from the time before administration of the study medication to 30 min later.DiscussionThis trial will determine the clinical utility of the association of paracetamol with morphine for pain management in the emergency room. The ADAMOPA trial will be conducted in accordance with the International Council on Harmonization Good Clinical Practices.Trial registrationEudraCT number: 2019-002149-39. ClinicalTrials.gov identifier: NCT04148495. Date of trial registration: November 1, 2019.

Validated HPLC–PDA methodology utilized for simultaneous determination of Etoricoxib and Paracetamol in the presence of Paracetamol toxic impurities

Etoricoxib (ETO), Paracetamol (PCM), and two toxic impurities for Paracetamol impurity K (4-aminophenol (PAP)) and impurity E (para-hydroxy acetophenone (PHA)) were separated using a simple and selective HPLC method that was tested for the first time. PCM is a commonly used analgesic and antipyretic medication that has recently been incorporated into COVID-19 supportive treatment. Pharmaceuticals containing PCM in combination with other analgesic-antipyretic drugs like ETO help to improve patient compliance. The studied drugs and impurities were separated on a GL Sciences Inertsil ODS-3 (250 × 4.6) mm, 5.0 µm column, and linear gradient elution was performed using 50 mM potassium dihydrogen phosphate adjusted to pH 4.0 with ortho-phosphoric acid and acetonitrile as mobile phase at 2.0 mL/min flow rate at 25 °C and UV detection at 220 nm. The linearity range was 1.5–30.0 µg/mL for ETO and PCM while 0.5–10.0 µg/mL for PAP and PHA, with correlation coefficients (r) for ETO, PCM, PAP, and PHA of 0.9999, 0.9993, 0.9996, and 0.9998, respectively. The proposed method could be used well for routine analysis in quality control laboratory.

Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: A prospective randomized study

Background: Hemodynamic alterations during general anesthesia with endotracheal intubation are due to stimulation of the sympathetic nervous system and catecholamine release. Therefore, it is important to attenuate these responses in pre-eclampsia patients who are already under stress. Aims and Objectives: The present study aimed to evaluate the combined efficacy of paracetamol, magnesium sulfate, and lignocaine in attenuating hemodynamic responses during intubation and perioperative period. Materials and Methods: Eighty ASA II pre-eclampsia patients were randomly divided into two groups. Group PLM received intravenous infusion of paracetamol (1 g) and magnesium sulfate (30 mg/kg) in 100 ml normal saline and IV bolus Inj. lignocaine (1.5 mg/kg) 15 min before induction. Group C received only IV infusion of 100 ml normal saline. Pulse rate (PR), blood pressure (BP), and oxygen saturation were measured at various time intervals up to 40 min of delivery of baby and in up to 240 min in post-operative period. Post-operative visual analog score (VAS) and the time for first rescue analgesia (TRA I) were recorded. Results: Demographic and baseline hemodynamic parameters were comparable in both groups (P>0.05). Changes in PR and BP during laryngoscopy, intubation, and perioperative period were significantly lesser in Group PLM as compared to Group C (P<0.05). The post-operative VAS score was significantly lower whereas TRA I was significantly longer in Group PLM than in Group C at all measuring times (P<0.05). Conclusion: Combination of paracetamol, magnesium sulfate, and lignocaine attenuates hemodynamic responses during laryngoscopy, intubation, and perioperative period along with prolonged post-operative analgesia in cesarean section under general anesthesia in pre-eclampsia patients.

“TO COMPARE THE EFFICACY OF INTRAVENOUS PARACETAMOL VS COMBINATION OF INTRAVENOUS PARACETAMOL AND MAGNESIUM SULPHATE ON POST OPERATIVE PAIN RELIEF.”

Introduction: Recent studies have shown the positive effect of magnesium sulphate as an adjunct on post-operative pain relief. This study is comparing effect of paracetamol with and without magnesium sulphate as an adjunct on post operating pain relief. AIMS: “To compare the efcacy of intravenous paracetamol vs combination of intravenous paracetamol and magnesium sulphate on post operative pain relief.” (1) To compare the duration of post operative Objectives: analgesia based on VAS score. (2) To note the requirement of rescue analgesia in the rst 24 hrs post operative period. This ra Materials And Methods: ndomised trial was conducted on 30 patients at Dr. D.Y.Patil medical college and research hospital. The patients who were candidates were randomised into two groups, Group 1 (n=15) and Group 2 (n=15). Spinal anaesthesia was given to all the patients. Group 1 were given 1 gm of IV paracetamol (100ml) with 100 ml of normal saline and group 2 were given 1gm of IV paracetamol (100ml) with 50mg/kg Magnesium sulphate in 100 ml of normal saline (max 2gm). VAS (visual analogue score) was used to assess post operative pain relief and requirement of rescue analgesia post operatively was measured. Result: There was a decrease inn rescue analgesic consumption and pain in the group receiving MgSo4 as an adjunct. In comparison to group 1, Group 2 showed statistically signicant reduction in post operative pain at 12, 24 and 36 hours. Intravenous MgSo4 with Conclusion: paracetamol is effective in reducing post operative pain and requirent of total opioid consumption in 72 hour post operative period as well as increased total duration of analgesia.

The Effect of Paracetamol and Codeine Analgesic Combination on Serum Alanine Aminotransferase and Aspartate Aminotransferase Levels in Male Wistar Rats

BACKGROUND: Paracetamol and codeine are classified as different analgesic categories with different mechanism. The combination of both paracetamol and codeine as an analgesic works synergistically and may give better outcome in pain management in moderate-to-severe degree. However, the combination of those analgesics might bring side effects in liver. AIM: This study was to determine the effect of analgesic combination of paracetamol and codeine on alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of Wistar rats. METHODS: This study was an experimental study with a pre- and post-test control group design. The study objects were 20 male Wistar rats with certain criteria, which were randomly divided into four groups, that is, control group (C), group with paracetamol therapy alone (32 mg/kgBW), group with codeine therapy alone (1.9 mg/kgBW), and group with combination therapy of paracetamol (32 mg/kgBW) and codeine (1.9 mg/kgBW). Analgesic drugs were administered orally 4 times a day for 28 days with gastric sonde. On the 29th day, blood samples were collected through retro-orbital blood vessels for measuring ALT and AST levels. Statistical tests used were one-way ANOVA and Kruskal–Wallis test. RESULTS: They showed that there were no differences in ALT levels between C, P1, P2, and P3 in both at baseline and post-treatment. However, there were significant increases in ALT levels after treatment in comparison to baseline in the control group (C) (87.2 ± 18.43 vs. 40.6 ± 5.02; p < 0.05), P1 (78.9 ± 8.52 vs. 44.4 ± 1.14; p < 0.05), and P3 (86.4 ± 17.22 vs. 44.0 ± 1.00; p < 0.05). There were no differences in AST levels between C, P1, P2, and P3 at baseline, but there were significantly higher AST levels in P1, P2, and P3 in comparison to control at post-treatment (p < 0.05). There were no differences in AST levels between P1, P2, and P3 at post-treatment (p > 0.05). There were also significant increases in AST levels after treatment in comparison to baseline in the control group (C) (93.9 ± 1.10 vs. 37.7 ± 1.69; p < 0.05), P1 (97.6 ± 1.85 vs. 36.3 ± 1.22; p < 0.05), P2 (97.6 ± 1.70 vs. 37.7 ± 1.73; p < 0.05), and P3 (98.6 ± 0.79 vs. 36.4 ± 1.20; p < 0.05). CONCLUSION: The combination therapy of paracetamol and codeine might not bring difference in serum ALT and AST levels compared to paracetamol therapy alone or codeine therapy alone.

Paracetamol, ibuprofen and dexamethasone for pain treatment after total hip arthroplasty: protocol for the randomised, placebo-controlled, parallel 4-group, blinded, multicentre RECIPE trial

IntroductionMultimodal analgesia with paracetamol, non-steroidal anti-inflammatory drug and glucocorticoid is recommended for hip arthroplasty, but with uncertain effects of the different combinations. We aim to investigate benefit and harm of...

Anaesthesia for elite athletes.

Sports participation has been growing rapidly since the 1960s. Anaesthesiologists are increasingly confronted with athletes in a peri-operative setting. The right choice of type of anaesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation. This review aims to give an overview of athletes' specific anaesthetic management in peri-operative and postoperative settings and to guide the nonspecialised anaesthetist. We comprehensively reviewed the literature, gathered all the information available on, and synthesised it in a narrative way, regarding preoperative evaluation, intraoperative implications and postoperative pain management of the elite athlete undergoing a surgical procedure. An anaesthesiologist should recognise the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarisation as normal features in the athlete's heart. Isotonic physiology typically produces four-chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Pre-operative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anaesthesiologist is mainly avoiding drugs on the prohibited list of the World Anti-Doping Agency (WADA). Postoperative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, injectable NSAIDs and local anaesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialised multidisciplinary pain clinics. This literature review aims to serve as a guide for the anaesthesiologist taking care of the elite athlete.

A prospective, single-arm, open-label, multicenter study to determine the safety and effectiveness of a fixed-dose combination of camylofin dihydrochloride and paracetamol in Indian children with acute colicky abdominal pain

Background: The aim of this prospective, single-arm, open-label, multicenter study was to determine the safety and effectiveness of a fixed dose combination of paracetamol and the antispasmodic camylofin dihydrochloride in Indian children with acute colicky abdominal pain.Methods: A total of 197 children with acute colicky abdominal pain were enrolled to receive 2 teaspoons (10 mL) of the syrup thrice daily orally for 5 days per local label. Primary objective was to assess safety as incidence of adverse events (AEs) and change in the severity and frequency of AEs from baseline to end of treatment (EOT). Secondary objectives were effectiveness as evaluated by change in mean (standard deviation [SD]) pain intensity (based on the 100-mm visual analog scale [VAS]) and mean change in the frequency of daily pain episodes from baseline to EOT.Results: In all, 182 (92.4%) patients completed the study. Twenty AEs were reported in 17 patients (8.7%). All AEs were treatment-emergent and of non-serious type. Common AEs included anemia, vomiting, and constipation. At EOT, mean pain intensity significantly (p<0.0001) reduced to 3.3 (8.50) with a mean change of -61.5 (19.56) from baseline. Percentage change in mean intensity of pain from baseline to EOT visit was 94.9%. At EOT, the frequency of daily pain intensity significantly (p<0.0001) reduced to 1.7 (1.01) with a mean change of -3.5 (2.14) from baseline.Conclusions: A fixed-dose combination of camylofin dihydrochloride and paracetamol was effective and well tolerated and had a good safety profile in Indian children with acute colicky abdominal pain.

Effectiveness between Duloxetine and Pregabalin for the Management of Neuropathic Chronic Low Back Pain

Background: Chronic low back pain has as a mixture of nociceptive and neuropathic component. This neuropathic component is often overlooked during management which increases the sufferings of patients. Prevalence of neuropathic pain is quite high and approximately 37% of chronic low back patients suffer from predominantly neuropathic pain. Treatment of neuropathic component of low back pain remains challenging and multiple modalities of treatments have been tried but not all of them are satisfactory. Among these, duloxetine and pregabalin have been shown to be promising in treatment of various neuropathic syndromes, but there is no direct comparative study between these two drugs in patients with back pain with neuropathic component. Objective of this study was to compare the effcetiveness between duloxetine and pregabalin which one reduce the pain and improve quality of life better.Methods: This is a prospective, observational study. Chronic low back pain patients with neuropathic components were recruited according to inclusion and exclusion criteria. Pain was measured by visual analog scale and neuropathic component measured by painDETECT questionnaire score. Patients were randomly assigned to either duloxetine or pregabalin group. Both drugs were initiated with their lowest dose. Duloxetine was started with 20mg/day with optional up titration to 60mg/day (20mg, weekly increments) and pregabalin was started with 50mg/day with optional up titration to 300mg/day (50mg weekly increments) for six weeks. A fixed dose combination of paracetamol and tramadol (325mg + 37.5mg) was used as rescue medication for breakthrough pain. Follow up were carried out weekly by face to face visits or over phone. At week four and six, additional assessment of patients’ quality of life was assessed by SF-36. The primary outcome parameter was mean VAS score and quality of life improvement by assessing SF-36 was secondary outcome parameter.Results: Out of 80 patients enrolled, 62 completed trial, eight patients in duloxetine and ten patients in pregabalin group dropped out. In this study, a significant reduction of pain intensity was observed with both Duloxetine and Pregabalin compared with their baseline values, but there was no statistically significant difference between the two treatments. The SF-36 score at the end of each treatment phase was significantly improved with both treatments. But when comparing in between two groups, the changes of mean SF-36 score was not significant as well.Conclusion: Both duloxetine and pregabalin are well-tolerated having good safety profiles. Further clinical trials with long term follow up are needed to determine their long term effect.

COMPARISON OF MULTIMODAL ANALGESIA FOR PAIN CONTROL AND MEASURING INFLAMMATION LEVELS USING PARACETAMOL WITH VARIOUS DOSAGE OF IBUPROPHENE IN CAESARIAN SURGICAL PATIENTS

The concept of multimodal analgesia in the treatment of postoperative pain has been around for a long time. Various drugs have been used to control pain after cesarean section (SC). The purpose of this study was to compare the combination of paracetamol with ibuprofen at various doses as multimodal analgesia and to measure levels of Interleukin-6 (IL-6) as a marker of inflammation in CS surgical patients. Methods this study was a single-blind experimental study. A total of 40 patients who underwent SC surgery under spinal anesthesia using hyperbaric Bupivacaine 0.5% 8 mg were divided into 2 groups, namely IBU4 group (paracetamol 750 mg and ibuprofen 400 mg), and IBU8 (paracetamol 750 mg and ibuprofen 800 mg) given intravenously 1 hour preoperatively, and every 6 hours for 24 hours. Then the degree of pain was assessed at rest and moving using a Numeric Rating Score (NRS) at 2, 4, 6, 12, and 24 hours postoperatively, and IL-6 levels were measured 1 hour preoperatively, 6 and 12 hours postoperatively. Calculate the amount of fentanyl given for rescue. Then repeated ANOVA, paired t-test, and chi-square analysis were performed using SPSS 21 for Windows. The results are declared meaningful if the p-value < 0.05. The results the IBU8 group showed lower values of the silent NRS, motion NRS, and IL-6 levels than the IBU4 group; this difference was significant with a value (p<0.05). All patients in the IBU8 group also did not require rescue fentanyl (p<0.05). The combination of paracetamol 750 mg and ibuprofen 800 mg showed the best results on NRS values, IL-6, and CRP levels for postoperative pain management SC without the need for rescue fentanyl and side effects.

Pentazocine versus tramadol-paracetamol combination as analgesia in labor: A randomized controlled trial

Objectives: Labor should be a satisfactory experience and effective pain management should be employed as recommended by the American Congress of Obstetricians and Gynaecologists. In developing countries, pain management in labor is still a big challenge and the search for the ultimate labor analgesia is still ongoing. The objectives of the study were to determine whether the synergistic analgesic effect of the combination of tramadol and paracetamol will produce analgesia comparable to pentazocine with a better side effect profile. Material and Methods: This was a randomized controlled, double-blinded trial of tramadol-paracetamol combination versus pentazocine as labor analgesia and was carried out at the University of Abuja Teaching Hospital, Abuja, between June 2018 and March 2019. A total of 218 eligible parturients recruited at term, were counseled on labor analgesia, its benefits, and the options made available to them and educated on the pain scoring system. Parturients were allocated into two groups using computer-generated numbers with the WINPEPI software. Group A was given tramadol-paracetamol combination, while Group B received pentazocine, both at standard doses. Hourly pain scores, APGAR scores, labor duration, patients’ satisfaction, and side effects were collated. The level of significance was set at <0.05. Results: Tramadol-paracetamol was administered to 109 (50.9%) while pentazocine was administered to 105 (49.1%) of the study participants. The mean age in the tramadol-paracetamol group was 29.6 ± 4.8 years, and in the pentazocine group, it was 28.8 ± 4.5 years. The difference in pain scores on the visual analog scale was statistically significant at the 3rd and 4th h (P = 0.02 and 0.004), but not significant in the 1st and 2nd h (P = 0.05 and 0.22) in the two groups. Overall, the average pain score in the tramadol-paracetamol group was significantly higher compared to the pentazocine group (5.27 ± 1.86 vs. 4.72 ± 1.54; P = 0.02). The 1st and 5th min APGAR scores (P = 0.44 and 0.67, respectively) of neonates in the tramadol-paracetamol and pentazocine groups were comparable. Nausea and drowsiness occurred more frequently in the pentazocine group at P-values of 0.047 and 0.0015, respectively. There was no statistically significant difference in the duration of labor between the tramadol-paracetamol and pentazocine groups. not statistically significant, a higher proportion of parturients in the pentazocine group was satisfied compared with the tramadol-paracetamol group (71.4% vs. 63.3%; P = 0.13). Conclusion: This study showed that intravenous pentazocine provides better pain relief in labor, but the tramadol-paracetamol combination has fewer side effects.

The analgesic efficacy of multimodal analgesia pathway after cesarean delivery

Background: Multimodal analgesia is a combination of analgesic methods that act on different sites of the pain pathway. The objective of this study was to evaluate the efficacy of multimodal analgesia after cesarean delivery (CD) and to investigate the adverse effects of these methods. Materials and method: A total of 180 women received spinal anesthesia for CD were divided into three groups. Group Para-TAP received paracetamol and transverse abdominis plane block (TAP block); group Para-Diclo received paracetamol and diclofenac; group Para-Diclo-TAP received paracetamol, diclofenac and TAP block. Paracetamol was given intravenously (IV) 1 g, orally 1 g every 8 h for 24 h, diclofenac was inserted rectally 1 h after surgery, TAP block were performed when uterine palpation caused a VAS score of 2 points. Pain score was measured with the visual analogue scale (VAS) at rest and on movement at 0, 2, 4, 6, 8, 12, 18 and 24 h for the first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h. The primary outcome was VAS score and the rate of analgesic request. The secondary measures of outcome were satisfaction with the pain management and side effects. Breakthrough pain was treated with 5 mg IV morphine when the VAS at rest ≥ 4 or on movement ≥ 5. Results: The VAS score ≤ 3 at rest of the 3 groups was 76.67%, 90% and 93.33%, respectively, the VAS score on movement ≤ 3 of the 3 groups was 38.33%, 61.67% and 76.67%, respectively. The rate of analgesic request of 3 groups was 23.33%, 10% and 6.7%, respectively, group Para-Diclo-TAP did not have the second analgesic request. All 3 groups had a low rate of itch and nausea, the difference between side effects was not significant. The Para-TAP group was more effective than the Para-Diclo group during the first 6h, the Para-Diclo group was more effectiveduring 12-24 h period, the Para-Diclo-TAP group was more ffective than the Para-Diclo group for a period of 18h. Conclusion: All 3 methods are effective in pain relief after CD, in which the combination of paracetamol, diclofenac, and TAP block brings outstanding efficiency but side effects are equivalent to other methods. Key words: Cesarean delivery, multimodal analgesia, paracetamol, NSAID, TAP block.

Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section.

Postoperative nausea and vomiting (PONV) are common symptoms after cesarean delivery (CD) that affect patients outcomes and satisfaction. The treatment of choice is still evolving, therefore, we aimed to evaluate PONV of combined paracetamol-dexamethasone vs. paracetamol alone. This study is a double-blind randomized controlled trial on 100 patients undergoing cesarean delivery. Participants were randomly assigned into two groups of paracetamol or combined paracetamol-dexamethasone. Nausea and vomiting score, VAS score of pain, and chill were compared between the two groups. The result of this study found that mild nausea 2ndh after surgery in the combined group was lesser than paracetamol group (0.03). However, there was no statistically significant difference in nausea and vomiting score in other periods of time between the two groups. VAS score of pain decreased 12th and 6th h after the surgery in the combined and paracetamol group, respectively. Chilling occurred in two patients of combined group and four patients of paracetamol group (p=0.432). Dexamethasone added to paracetamol might not improve pain and vomiting after cesarean delivery comparison with just paracetamol. But it can be effective for reducing the score of nausea after the surgery.

Maternal over-the-counter analgesics use during pregnancy and adverse perinatal outcomes: cohort study of 151 141 singleton pregnancies

ObjectivesTo identify any associations between in utero exposure to five over-the-counter (non-prescription) analgesics (paracetamol, ibuprofen, aspirin, diclofenac, naproxen) and adverse neonatal outcomes.DesignRetrospective cohort study using the Aberdeen Maternity and Neonatal...

Effect of intravenous fentanyl versus intravenous fentanyl and paracetamol in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation

Laryngoscopy and endotracheal intubation are potent stimuli causing increased sympathoadrenal activity. The objective of this study is to assess and compare the effects of intravenous fentanyl versus a combination of intravenous fentanyl and paracetamol in blunting the hemodynamic responses to laryngoscopy and endotracheal intubation. Sixty patients of ASA status I and II, aged 18-60 years of either sex posted for surgeries under general anaesthesia were selected. Patients in group A received intravenous fentanyl 2mcg/kg. Patients in group B received intravenous fentanyl 2mcg/kg and paracetamol 15mg/kg. After intubation vital parameters were recorded at 1, 2, 4 and 6 minute and later once every 10minutes.: After intubation, there was an initial increase in heart rate in both groups. However, this was significantly higher (p=0.004) with group A as compared to group B and remained significantly high for another 6 minutes(p=0.03).There was an increase of mean arterial pressure after intubation in both the groups, however, this was significantly higher in group A and remained significantly high for 6 minutes as compared to group B[p=0.003]. Mean SpO2 was similar in both the groups, and there were no complications during the study. Intravenous fentanyl and paracetamol is more effective in blunting the hemodynamic responses due to laryngoscopy and endotracheal intubation when compared to intravenous fentanyl alone.

CURRENT APPROACHES TO PERIOPERATIVE MANAGEMENT OF PATIENTS WITH INGUINAL HERNIAS (LITERATURE REVIEW)

The article provides literature review on current approaches to perioperative treatment of patients with inguinal hernias (IH) based on the principles of enhanced recovery after surgery (ERAS). The ERAS algorithm includes all evidence-based perioperative elements that affect rapid recovery after surgery, reduce the incidence of complications and potential mortality. There are three stages of patient management: preoperative examination, selection of an adequate method of surgical treatment, anesthesia during surgery and in the postoperative period. Thorough examination of patients before surgery and identification of potential risk factors associated with comorbidities are important to reduce the risk of morbidity and recurrences. Effective dynamic perioperative pain management is a prerequisite for optimal recovery after surgery. The first step in managing pain under the ERAS concept is choosing the correct type of surgery. Preference should be given to the least traumatic operations, i.e., laparoscopic or endoscopic hernioplasty. According to PROSPECT recommendations, analgesics should be started before and continued during surgery, which will provide adequate analgesia in the early postoperative period. The combination of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) and a selective cyclooxygenase-2 inhibitor (COX-2) provides good analgesia and reduces opioid use. The transverse abdominal block (TAP block), as a type of regional anesthesia, is safe for patients with IH, reduces the postoperative need for narcotic analgesics, reduces the frequency of postoperative nausea and vomiting and pain intensity. Regional anesthesia reduces the length of a patient’s stay in the operating room and is associated with a lower risk of urinary retention in the postoperative period (compared to neuroaxial anesthesia). After the operation patient should be activated as soon as possible, and this is possible under conditions of sufficient analgesia, which is best achieved by combining systemic analgesics and TAP block. Antimicrobial prophylaxis should be performed in all patients undergoing elective surgery for IH. Since some patients experience significant limitations in daily activities due to chronic postoperative inguinal pain, it is necessary to consider all risk factors for chronic pain after surgery to prevent its development.

Clinical Response of Nuberol Forte® for Pain Management With Musculoskeletal Conditions in Routine Pakistani Practice (NFORTE-EFFECT)

BackgroundMusculoskeletal pain is the most common complaint presented to the health practitioner. It is well-known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL).ObjectivesThe current study aimed to assess the clinical response of Nuberol Forte® (paracetamol 650 mg + orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL.MethodsA prospective, observational multicenter study (NFORT-EFFECT: Safety & Efficacy of Nuberol Forte in Pain Management). Three hundred ninety-nine patients with known prescreened musculoskeletal pain were recruited from 10 major healthcare facilities across six (6) major cities of Pakistan, as per the inclusion/exclusion criteria. After the baseline visit (Visit 1), the patients were followed up one to two weeks (Visit 2) after the treatment as per the physician's discretion. Data were collected using the Case Report Form (CRF) designed for the study, and adverse events (AEs) were also monitored to assess drug safety. Pain intensity was assessed through a visual analog scale (VAS), and QoL was assessed using the Muscle and Joint Measure (MJM) scale.ResultsOut of 399 enrolled patients, 49.4% were males and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with knee osteoarthritis (OA), i.e., 148 (38%), followed by backache 70 (18.2%). A significant reduction in the mean pain score was observed after treatment with the combination of paracetamol and orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only 10 patients reported mild adverse events (AEs), namely, dryness of the mouth, dizziness, gastric irritation, tachycardia, restlessness, etc.ConclusionThe combination of paracetamol and orphenadrine (Nuberol Forte) exhibited effective pain management among patients with musculoskeletal conditions and improved their QoL.

Opioid-free anaesthesia for laparoscopic surgeries - A prospective non-randomised study in a tertiary care hospital

Background and Aims:Opioids have nowadays become superfluous because of their adverse effects involving post-operative recovery of the patients. So, we aimed at comparing opioid-free anaesthesia with opioid-based technique for post-operative pain relief in laparoscopic surgeries. The primary objective was to assess the pain scores in the post-operative period using visual analogue scale (VAS) for 24 h, and the secondary objective was to compare intraoperative haemodynamic parameters, duration of postoperative analgesia and total analgesics consumed in the first 24 h.Methods:This study was conducted in 60 patients aged between 20 and 70 years, belonging to the American Society of Anesthesiologists physical class I and II posted for laparoscopic surgeries. Anaesthetic doses of lidocaine, magnesium and paracetamol in combination with fascial plane block for post-operative pain relief were given for 30 patients, and the other 30 patients received the conventional opioid-based anaesthesia. Mann–Whitney test was used for VAS scores, and Friedman test was used for repeated measures comparison.Results:VAS scores were higher in the conventional group as compared to the opioid-free group at 0, 2, 4, and 6 h during rest and at 0, 2, 4, 6, 24 h during movement and were statistically significant (P-value < 0.05). The duration of analgesia for the conventional group was 13.8 + 6.7 h, and for opioid-free anaesthesia was 6.7 + 2.2 hours. Intraoperative haemodynamic parameters did not show a statistically significant difference except for systolic blood pressure which was higher in the opioid-free group but was clinically insignificant. (P-value 0.013).Conclusion:Opioid-free anaesthesia along with erector spinae plane block provides better post-operative pain relief when compared to conventional opioid anaesthesia.