Paracetamol Group Research Articles

Effects of Thymoquinone Nanoparticles on Paracetamol-Induced Nephrotoxicity by Mitigating Oxidative Stress and Inflammation in Rats

Abstract A common and efficient analgesic-antipyretic medication for a variety of syndromes is paracetamol (PAR). The use of PAR was associated with acute kidney injury and other side effects, and its hazardous effects were influenced by oxidative stress and inflammation. Black seed oil’s primary active ingredient, thymoquinone (TQ), has anti-inflammatory, immunomodulatory, and antioxidant properties. A few animal models for drug-induced nephrotoxicity described promising outcomes of its renoprotective action. The main goal of this work was to evaluate TQ nanoparticles’ (TQNP) powerful renoprotective properties in a rat model of nephrotoxicity caused by PAR. Three groups of eight rats each were assigned; group one (the control group, CON) was given gavaged normal saline. Group 2 (PAR group, PAR) received 600 mg/kg of gavaged PAR diluted in regular saline. One hour after PAR delivery, group 3 (the TQNP group) received TQNP 0.5 mg/kg via oral administration. In rat kidney tissues, PAR resulted in renal damage, a rise in blood urea nitrogen (BUN), creatinine, cystatin C (CYC), myeloperoxidase, protein carbonyl (PC), malondialdehyde (MDA), and a decrease in nitric oxide and cellular antioxidants. In rats given PAR, TQNP effectively reduced renal damage, lowered serum levels of creatinine, BUN, and CYC, and improved oxidative stress (MDA, MYO, and PC) and inflammatory markers (TNFα and IFN-γ). TQNP treatment resulted in modestly dilated/congested blood vessels in the renal tissues of PAR. The TQNP’s renoprotective action is an effective preventative against PAR-induced nephrotoxicity, primarily by enhancing cellular defense mechanisms and reducing inflammatory and oxidative indicators in a rat model. However, additional research and clinical trials should be needed for testing in future studies.

Emergence Agitation: Comparison of Paracetamol and Tramadol in Elective Surgery Patients

Background: Post-operative emergence agitation is frequent and self-limiting but at times may present with violent behavior and may result in harm to both patients and caregivers. The objective of this research is to find the incidence of emergence agitation and to compare the effects of paracetamol and tramadol on emergence agitation.Methods: A quasi experimental study was conducted in the Department of Anesthesiology, College of Medical Sciences, Bharatpur, Chitwan, Nepal over a period of three months. One hundred fifty ASA I and II patients aged 18 – 45 years old, posted for elective surgery under general anesthesia were included. Patients were assigned into two equal groups of 75 patients (n=75). At the end of the surgery, group A received inj. tramadol 1mg/kg, just when the surgeon starts skin closure and group B received 15 mg/kg Paracetamol. Time taken for extubation, shivering, Richmond agitation sedation scale (RASS) and sedation and Visual analogue scale (VAS) and need of rescue analgesics were recorded. Results: In paracetamol group, reversal to extubation time was 8.75±3.0 minutes which was higher compared to 6.21±1.84 minutes in tramadol group. Prevalence of shivering was higher in paracetamol group. VAS score in paracetamol group was 5.28±1.03 compared to 4.33±0.82 in tramadol group. Frequency of need of rescue analgesia was higher in paracetamol group. In the immediate postoperative period, agitation was more common. Conclusion: Use of tramadol before extubation reduces the incidence of postoperative emergence agitation, immediate postoperative pain and shivering.

The Hepatoprotective Effect of Omega-7 Against Paracetamol-Induced Hepatotoxicity in Male Rats

Abstract Paracetamol toxicity, whether accidental or not is a worldwide issue that leads to hepatotoxicity, acute liver failure, as well as irreversible liver injury requiring liver transplantation. Omega-7 is a monounsaturated fatty acid with a number of beneficial properties. The aim of the present study was to assess the potential protective role of omega-7 fatty acid against hepatotoxicity induced by paracetamol in male rats. Thirty male Rats were separated into five groups (six rats in each group) and received the following treatment: group 1 received liquid paraffin orally via gavage tube for seven days successively, group 2 received liquid paraffin orally via gavage tube for seven days successively, and on day eight, rats received a single intraperitoneal injection of paracetamol (500 mg/kg/day), group 3 received omega-7 (300 mg/kg/day) orally via gavage tube for seven days successively, group 4 received omega-7 (100 mg/kg/day) orally via gavage tube for seven days successively, and on day eight, rats received a single intraperitoneal injection of paracetamol (500 mg/kg/day), group 5 received omega-7 (300 mg/kg/day) orally via gavage tube for seven days successively, and on day eight, rats received a single intraperitoneal injection of paracetamol (500 mg/kg/day). On day nine, rats have been sacrificed by cervical dislocation and liver homogenate samples were collected for analysis. This study showed that there was a significant decrease in hepatic superoxide dismutase, catalase, glutathione-peroxidase and glutathione levels, accompanied with significant increase in hepatic malondialdehyde level in paracetamol group compared to the negative control group. However, administration of omega-7 resulted in significant increase in hepatic superoxide dismutase, catalase and glutathione levels and significant decrease in hepatic malondialdehyde level compared to paracetamol group. In conclusion, omega-7 has a protective effect on paracetamol-induced hepatotoxicity in rats. Keywords: Antioxidant, Hepatotoxicity, Omega-7, Oxidative stress, Paracetamol.

Paracetamol add-on treatment for perioperative pain management in dogs undergoing single-site thoracolumbar hemilaminectomy: a prospective clinical study

In this prospective, double-blinded, randomized, clinical trial, it was evaluated whether paracetamol, as an adjunct to NSAID and opioid analgesia, might limit the requirements for intraoperative fentanyl and postoperative methadone administration in dogs undergoing a singlesite thoracolumbar hemilaminectomy for surgical treatment of an intervertebral disc extrusion. Twelve client-owned dogs were randomly assigned to two multimodal analgesia groups: NSAID + paracetamol group (group NP) and NSAID + placebo group (group N). Intraoperative analgesic assessment was based on the clinical evaluation of a nociceptive response, whereas postoperative analgesic assessment was determined by using the short form of the Glasgow Composite Pain Scale. No statistically significant difference was found in both groups for the intraoperative need for fentanyl (P = 0.18). The probability of having to administer rescue analgesia postoperatively was significantly higher in group N than in group NP (P = 0.01). For both groups, there were no serious side effects reported, nor was any significant difference found between both groups regarding the occurrence of side effects (P = 0.55). Despite multimodal perioperative pain management consisting of a full μ-agonist opioid, a NSAID and paracetamol, intraoperative rescue analgesia was still required, although the need for postoperative opioid based analgesia was significantly lower in group NP.

Perbandingan parasetamol dan petidin sebagai profilaksis menggigil pada pasien dengan anestesi spinal

Background: Shivering is a frequent complication in patients undergoing surgery under neuraxial anesthesia. Shivering can increase oxygen consumption and lead to hypothermia, so it must be prevented.Objectives: This study aims to determine the difference between intravenous paracetamol and pethidine to prevent shivering after spinal anesthesia.Methods: This research is a double-blind, randomized, controlled clinical trial. This research was conducted at Haji Adam Malik General Hospital, Medan. This research was done in August 2022. The research sample was patients with spinal anesthesia at the Haji Adam Malik General Hospital Medan who met the research criteria. The Modified Crossley and Mahajan Scale (1-4) measured the degree of shivering. The subjects who met the inclusion criteria were 34 patients, with 17 patients in the group receiving pethidine and 17 receiving paracetamol. The data that will be collected is analyzed with the bivariate test using the Chi-square test CI 95% to compare categorical variables. Of the 34 patients, 17 patients in the group received pethidine, and 17 patients in the group received paracetamol. Furthermore, both groups were randomized to obtain a balanced group of 17 patients in each group.Results: In this study, the degree of shivering in the paracetamol and pethidine groups did not show a statistically significant difference with the value (p= 0,450). However, the highest degree of shivering was found in the paracetamol group with a score of 2 (significant tremor in the chest muscles), about 17,6%. While in the pethidine group, most scores suffer shivering, the highest score being 1 (intermittent and mild tremors in the jaw and neck muscles).Conclusion: There is no difference in the effect of paracetamol and pethidine as shivering prophylaxis in preventing post-spinal anesthesia shivering.

Effect of timing of intraoperative administration of paracetamol on postoperative shivering: A randomised double-blind controlled trial.

Paracetamol (PCM) has an anti-shivering effect and may also exacerbate intraoperative hypothermia. This study compares the incidence of shivering as the primary outcome and the incidence of perioperative hypothermia (<36°C) and the time to the analgesic requirement as secondary outcomes when PCM was administered after induction of anaesthesia or towards the end of surgery. In this randomised study, 225 adult patients of either gender undergoing elective surgical procedures under general anaesthesia with an expected duration of surgery of 1-4 h were studied. They received intravenous (IV) PCM 15 mg/kg (maximum 1 g) immediately after anaesthesia induction (Early PCM group), 30 min before completion of surgery (Late PCM group) or no PCM (Control group). IV morphine 0.1 mg/kg was administered for analgesia in all three groups. The Chi-square test and repeated measures analysis of variance followed by Tukey's test were used for statistical analysis. The incidence of shivering was lower in Late PCM (12%) than in Early PCM (29.3%) (P = 0.009) and Control groups (30.6%) (P = 0.005). The incidence of postoperative hypothermia was also significantly lower in the Late PCM group than in the Early PCM (P = 0.002) and Control groups (P = 0.016). Early PCM and Control groups did not significantly differ. The number of patients requiring postoperative analgesia was smaller, and the time to the analgesic requirement was longer in Late PCM compared to other groups. Administration of IV PCM 30 min before completion of surgery results in a lower incidence of postoperative shivering and hypothermia when compared to PCM administered after induction of anaesthesia or no PCM.

Associations between the use of common nonsteroidal anti-inflammatory drugs, genetic susceptibility and dementia in participants with chronic pain: A prospective study based on 194,758 participants from the UK Biobank

ObjectiveTo investigate the potential relationship between common nonsteroidal anti-inflammatory drugs (NSAIDs), genetic susceptibility and all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VD) among individuals experiencing chronic pain. MethodsThis study was based on 194,758 chronic pain participants form UK biobank with a median follow-up of 13.7 years. Participants were categorized into different NSAIDs painkiller regimen groups: No NSAIDs group, Aspirin group, Ibuprofen group, Paracetamol group, and 2–3 NSAIDs group. Cox proportional risk models were used to examine the correlation between regular NSAIDs usage and the risk of ACD, AD, and VD. In addition, we further performed subgroup analyses and sensitivity analyses. Results1) Compared to the No NSAIDs group, the aspirin group (HR = 1.12, 95% CI:1.01–1.24, P < 0.05), the paracetamol group (HR = 1.15, 95% CI:1.05–1.27, P < 0.01), and the 2–3 NSAIDs group (HR = 1.2, 95% CI:1.08–1.33, P < 0.05) showed a higher risk of ACD. Furthermore, the 2–3 NSAIDs group was also associated with a higher risk of VD (HR = 1.39, 95% CI: 1.08–1.33, P < 0.05). 2) At high dementia GRS participants with chronic pain, the paracetamol group (HR = 1.2, 95% CI: 1.03–1.43, P < 0.05) and the NSAIDs group (HR = 1.3, 95% CI: 1.07–1.59, P < 0.05) were associated with a higher risk of ACD compared to the no painkiller group. 3) There was no significant association between ibuprofen use and higher risk of dementia. ConclusionIn individuals with chronic pain, the use of aspirin and paracetamol was associated with a higher risk of ACD, whereas the use of ibuprofen was not significantly associated with a higher risk of ACD.

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p&lt;0.05), as well as less side effects in the form of nausea and vomiting (p &lt; 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine.

Применение молекулярно-генетических предикторов и машинного обучения в оценке токсичности химических веществ

Toxic hepatites is an important public health issue in Russia. They have diverse etiologies, including industrial toxins, drugs, and ethanol, leading to significant differences in pathogenesis at the molecular and genetic level. This study aimed to analyze genes involved in the response to toxic liver injury of different origins and to establish a model to predict the etiology of toxic hepatitis. To model acute toxic hepatitis, outbred white male rats weighing 180–200 g were used. They were divided into four groups: control group, tetrachloromethane group, paracetamol group, and ethanol group. 24 h and 72 h after toxicant administration rats were anesthetized and mRNA levels of Chek1, Gclc, Gstm1, Gstp1, Gstt1, Nfe2l2, Nqo1, and Ripk1 genes in liver homogenate were studied. Analysis of the expression of these genes showed that the expression profile varies depending on the etiology of toxic hepatitis. In tetrachloromethane poisoning, there was a marked increase in gene expression of Nqo1 (p?=?0.001), Gstm1 (p?=?0.037), and a decrease in gene expression of Nfe2l2 (p?=?0.004), Ripk1 (p?=?0.004). However, liver exposure to paracetamol and its metabolites resulted in decreased Gstm1 gene expression (p?=?0.001) and increased Nfe2l2 (p?=?0.009), Gclc (p?=?0.001), and Chek1 (p?=?0.011) gene expression. No significant changes in the expression of these genes are found in alcohol intoxication. A model was constructed to predict the etiology of toxic hepatitis on the basis of gene expression indices. Keywords: acute toxic hepatitis, paracetamol, tetrachloromethane, ethanol, gene expression.

Efficacy of Tenoxicam, Paracetamol, and Their Combination in Postoperative Pain After Double-Jaw Surgery.

Introduction Orthognathic surgical procedures include a series of surgical operations in which interventions are applied to the maxilla, mandible, or both for occlusal or aesthetic concerns due to facial skeletal development deformities. Double-jaw surgeries have the highest pain scores, in which both maxilla and mandible bones are intervened. This study aimed to compare the efficacy of individual applications of paracetamol and tenoxicam with their combined application on postoperative pain and opioid consumption in patients undergoing double-jaw surgery. Methods In this randomized, double-blind study, 60 patients undergoing double-jaw surgery were allocated into three groups, with each having 20 patients: the paracetamol group, the tenoxicam group, and the paracetamol-tenoxicam combination group. Pain intensity was evaluated using the visual analogue scale (VAS) at intervals of 30 minutes, 60 minutes, 120 minutes, and again at the 24th postoperative hour. Additionally, the consumption of opioids and other rescue analgesics was documented over the 24-hour postoperative period. Results The VAS values at 30 minutes, 60 minutes, and 24 hours were lower in the paracetamol-tenoxicam group compared to the other groups (p<0.001). The need for a rescue analgesic drug in the first 24 hours was not observed in the tenoxicam and paracetamol-tenoxicam groups. Conclusion It was concluded that both tenoxicam and paracetamol-tenoxicam combinations, especially the tenoxicam-paracetamol combination, were good options for postoperative analgesia in patients with double-jaw surgery.

The effect of paracetamol on the parasitological diagnosis of Plasmodium falciparum malaria

Objectives: Up until the present time, malaria represents an immense public health problem worldwide with a significant morbidity and mortality rate in many developing countries including Sudan. The use of antipyretics and analgesics in the settings of malaria has been a matter of contention over a vast period of time. Now, it is widely believed among the public and some health professionals in Sudan that the antipyretic and analgesic paracetamol disturbs the accuracy of the parasitological diagnosis of malaria. This study investigates the magnitude and effects of that belief through a descriptive study and examines the actual effect of paracetamol on the parasitological diagnosis of falciparum malaria through a clinical trial. Material and Methods: This is a conjoined study that includes a prospective and descriptive study and a randomized, placebo-controlled, double-blind, and parallel-group clinical trial. The descriptive study included 846 participants from various states in Sudan. The targeted study subjects were the public and health professionals and the study was conducted utilizing an online-based questionnaire. The clinical trial included 325 patients with uncomplicated falciparum attending two primary healthcare outpatient clinics in Gezira state, Sudan. The patients were randomly allocated to receive either placebo tablets or 500 mg of oral paracetamol after the first blood smear sample was taken. The second blood smear samples were taken 2 h after taking treatment. Parasite density estimation and other parasitological data were obtained from each sample before and after treatment. Results: The majority of the public thinks that paracetamol affects the parasitological diagnosis of malaria (76.21%, n = 330/433). Personal experience and family and friends were the most dominant information sources for the public (31.20% and 28.01% respectively), while scholarly articles were the most common source of information for the health professional group (45.03%, n = 186/413). No significant differences between the parasitological findings acquired before and after taking the treatments among both the paracetamol group (P = 0.22) and the placebo group (P = 0.12). The parasite density mean for the paracetamol group differed by 16.31 P/μL after taking paracetamol, while the placebo group parasite density mean differed by 15.34 P/μL. The treatments did not inflict impacts on the advanced microscopic features of Plasmodium falciparum blood smears. Conclusion: Paracetamol does not affect the parasitological diagnosis of falciparum malaria.

Unlocking the Optimal Analgesic Potential: A Systematic Review and Meta-Analysis Comparing Intravenous, Oral, and Rectal Paracetamol in Equivalent Doses.

Paracetamol (acetaminophen) is an extensively used analgesic for acute and chronic pain management. Currently, paracetamol is manufactured for oral, rectal, and intravenous (IV) use. Research has shown varied results on the analgesic properties of IV paracetamol compared to oral and rectal paracetamol; however, research on the same doses of paracetamol is limited. Therefore, this review was constructed to explore the analgesic properties of IV paracetamol compared with oral and rectal paracetamol administered in equivalent doses. A broad and thorough literature search was performed on five electronic databases, including PubMed, ScienceDirect, Medline, Scopus, and Google Scholar. Statistical analysis of all outcomes in our review was then performed using the Review Manager software. Outcomes were categorized as primary (pain relief and time to request rescue analgesia) and secondary (adverse events after analgesia). An extensive quality appraisal was also done using the Review Manager software's Cochrane risk of bias tool. The literature survey yielded 2,945 articles, of which 12 were used for review and analysis. The pooled analysis for patients undergoing surgical procedures showed that IV paracetamol had statistically similar postoperative pain scores at two (mean difference (MD) = -0.14; 95% confidence interval (CI) -0.58-0.29; p = 0.51), 24 (MD = 0.09; 95% CI = -0.02-0.21; p = 0.12), and 48 (MD = 0.04; 95% CI = -0.08-0.16; p = 0.52)hours as oral paracetamol. Similarly, the data on time to rescue analgesia showed no considerable difference between the IV and oral paracetamol groups (MD = -1.58; 95% CI = -5.51-2.35; p = 0.43). On the other hand, the pooled analysis for patients presenting non-surgical acute pain showed no significant difference in the mean pain scores between patients treated with IV and oral paracetamol (MD = -0.35; 95% CI = -2.19-1.48; p = 0.71). Furthermore, a subgroup analysis of analgesia-related adverse events showed that the incidences of vomiting/nausea and pruritus did not differ between patients receiving IV and oral paracetamol (odds ratio (OR) = 0.71; 95% CI = 0.45-1.11; p = 0.13 and OR = 0.48; 95% CI = 0.18-1.29; p = 0.05, respectively). A review of information from two trials comparing equal doses of IV and rectal paracetamol suggested that the postoperative pain scores were statistically similar between the groups. IV paracetamol is not superior to oral or rectal paracetamol administered in equal doses. Therefore, we cannot recommend or refute IV paracetamol as the first-line analgesia for acute and postoperative pain.

Comparative Evaluation of Postoperative Pain Scores and Opioid Consumption in Septorhinoplasty After Administration of Single-Dose Preemptive Paracetamol and Ibuprofen: A Randomized Controlled Trial.

Introduction Septorhinoplasty operates on the nose's bone and cartilage and is ensued by severe postoperative pain. Objective The objective of this study is to evaluate the effects of preoperative administration of intravenous (IV) paracetamol and ibuprofen on postoperative pain scores in patients undergoing septorhinoplasty. Methods A total of 150 patients undergoing septorhinoplasty were randomly assigned into 3 groups with 50 patients in each group. The control group (group A) was administered 100 ml saline solution; the paracetamol group (group B) was administered 1,000 mg of IV paracetamol in 100 ml of saline solution; and the ibuprofen group (group C) was administered 800 mg of IV ibuprofen in 100 ml of saline solution before surgery. Opioid analgesics were employed to achieve postoperative analgesia. Postoperative pain was evaluated using the visual analogue scale (VAS). Postoperative opioid consumption and adverse effects were also recorded for each patient. Results In comparison with group A, the score in the VAS of groups B and C was statistically lower in all the time intervals ( p < 0.05). In the 1 st and 6 th hours postoperatively, group C's score in the VAS in was lower than that of group B ( p < 0.05). In the control group, total opioid consumption was highest in all time intervals ( p < 0.05). In group C, total opioid consumption was significantly lower than in group B in the 0 to 6 and 6 to 12 hours intervals. ( p < 0.05). Conclusion The single-dose preemptive administration of ibuprofen has a more profound postoperative analgesic effect than paracetamol in the first 6 hours after septorhinoplasty. After the first 6 hours postsurgery, there is no difference between ibuprofen and paracetamol in terms of analgesic effect.

Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia

Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value &amp;lt; 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.

Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia

Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value &amp;lt; 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.

Efficacy of expressed breast milk alone or in combination with paracetamol in reducing pain during retinopathy of prematurity screening: A randomized controlled trial

Background: The aim of this study was to determine the efficacy of expressed breast milk (EBM) alone or in combination with oral paracetamol for pain reduction during retinopathy of prematurity (ROP) screening. Methods: A randomized control trial was conducted in two departments of Bangabandhu Sheikh Mujib Medical University. A total of 60 preterm neonates who underwent ROP screening were randomized into three equal groups. Group A got nesting and swaddling as per institutional protocol (control). Group B received 2 ml EBM two minutes prior to the ROP screening and Group C received 15 mg/kg syrup paracetamol 30 minutes prior to the ROP screening and EBM like Group B. Premature infant pain profile (PIPP) scores was used prior, during and 2 minutes after ROP screening procedure. Results: The three groups were similar in terms of baseline characteristics. The mean (standard deviation) PIPP scores during the procedure were 16.4 (1.1), 15.0 (1.8) and 13.4 (1.8) in control, EBM, and EBM with paracetamol groups respectively. The PIPP scores were significantly lower in the EBM and EBM with paracetamol groups during the procedure compared to control group. In the EBM and EBM with paracetamol groups, the mean difference in PIPP scores (between before and during the procedure) was also substantially lower. Conclusion: Breast milk alone or in combination with paracetamol can reduce significant pain during ROP screening than control group.

Analgesic effect of oral paracetamol 1000 mg/ibuprofen 400 mg, paracetamol 1000 mg/codeine 60 mg, paracetamol 1000 mg/ibuprofen 400 mg/codeine 60 mg, or placebo on acute postoperative pain: a single-dose, randomized, and double-blind study

PurposeCombining analgesics with different mechanisms of action may increase the analgesic efficacy. The multidimensional pharmacodynamic profiles of ibuprofen 400 mg/paracetamol 1000 mg, ibuprofen 400 mg/paracetamol 1000 mg/codeine 60 mg, and paracetamol 1000 mg/codeine 60 mg and placebo were compared.MethodsA randomized, double-blind, placebo-controlled, parallel-group, single-centre, outpatient, and single-dose study used 200 patients of both sexes and homogenous ethnicity after third molar surgery (mean age 24 years, range 19–30 years). Primary outcome was sum pain intensity over 6 h (SPI). Secondary outcomes were time to analgesic onset, duration of analgesia, time to rescue drug intake, number of patients taking rescue drug, sum pain intensity difference (SPID), maximum pain intensity difference, time to maximum pain intensity difference, number needed to treat, prevent remedication and harm values, adverse effects, and patient-reported outcome measure (PROM).ResultsAnalgesia following ibuprofen and paracetamol combination with or without codeine was comparable. Both were better than paracetamol combined with codeine. Secondary variables supported this finding. Post hoc analysis of SPI and SPID revealed a sex/drug interaction trend in the codeine-containing groups where females experienced less analgesia. PROM showed a significant sex/drug interaction in the paracetamol and codeine group, but not in the other codeine-containing group. Especially females reported known and mild side effects in the codeine-containing groups.ConclusionCodeine added to ibuprofen/paracetamol does not seem to add analgesia in a sex-mixed study population. Sex may be a confounding factor when testing weak opioid analgesics such as codeine. PROM seems to be more sensitive than traditional outcome measures.Trial registrationClinicalTrials.gov June 2009 NCT00921700.

Comparison of Analgesic Effect of Intravenous Paracetamol with Intravenous Ketorolac in Patients Presenting With Renal Colic in the Emergency Department

Objective: To compare the effects of intravenous (IV) Paracetamol and intravenous (IV) Ketorolac in pain management of patients with renal colic presenting to the emergency department (ED).&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021.&#x0D; Methodology: Eighty patients were included in the study who were selected and divided into two groups, one receiving Paracetamol 1 g intravenous (PC-Group) and the other receiving Ketorolac 30 mg IV (KET-Group). Their effect was compared using differences in visual analogue scale (VAS) before and after giving analgesia. Record of vital signs pre and post-drug administration, adverse effects and need for rescue analgesia was maintained (Nalbuphine). If further analgesia was required, 100 mg intravenous was used as the rescue drug.&#x0D; Results: Ketorolac (KET) Group had a mean age of 37.60±14.56 years, while the Paracetamol (PC) Group had a mean age of 43.2 ± 16.05 years. There was no statistically significant difference in the reduction of pain intensity after giving the drug in the respective study Groups (p=0.09). Adverse effects (p=0.17) and the need for rescue analgesia (p=0.34) were also comparable between the two Groups.&#x0D; Conclusion: The use of either intravenous-PC or intravenous-KET in patients with renal colic had similar analgesic effects with no significant difference in side effects and need for rescue analgesia.

Paracetamol Versus Ondansetron for Prevention of Postoperative Shivering in Liposuction Surgeries Under Combined General Epidural Anaesthesia: A Randomized Controlled Trial.

Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia. One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects. The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (P <0.001). Tympanic temperature and complications were comparable between the groups with no significant differences. Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.

Treatment of Patent Ductus Arteriosus in Premature Infants: Intravenous Paracetamol or Oral Ibuprofen?

The similarity in the mechanism of action between paracetamol and ibuprofen can cause similar side effects. However, in preterm neonates with feeding intolerance, intravenous (IV) paracetamol has replaced oral ibuprofen. Therefore, a comparison of the effectiveness and side effects is essential. In this retrospective cohort study, the data of 118 preterm infants with a definite diagnosis of patent ductus arteriosus (PDA), including 59 patients who received oral ibuprofen and 59 patients who received IV paracetamol were analyzed. Laboratory evaluations of serum total and direct bilirubin, hemoglobin, and creatinine levels before and seven days after treatment were made. Using analysis of covariance (ANCOVA) and multiple multinomial logistic regression models, the effect of two treatment groups on the post-treatment variables as well as their efficacy comparison were evaluated. In both pre- and post-treatment periods, there was no significant association between echocardiography variables with treatment groups. The results from the ANCOVA model showed that the paracetamol and ibuprofen were followed by a significant decrease in the mean total bilirubin and Hct variables after treatment by 1.38 and 1.65 units, respectively. In addition, results from the Mann-Whitney U test revealed that the median Hb and K differences after and before treatment had a significant difference between the two treatment groups. Furthermore, based on the multiple multinomial logistic model results, the odds of complete arterial duct closure with IV paracetamol was 1.27 times higher than with oral ibuprofen, while in the oral ibuprofen group, the odds of closing was 1.44 times higher than the IV paracetamol group, but there was no statistically significant difference between the two groups. Intravenous paracetamol has equal efficacy compared to oral ibuprofen in the treatment of PDA. Also, it seems to be associated with a lower risk of hyperbilirubinemia following the treatment.