بررسی اثرتزریق پاراستامول وریدی در انتهای عمل جراحی بر میزان درد پس از عمل سزارین

Subject Areas : علوم پزشکی

Hamed Beyzaee ¹ , Maria Alian ² , Parisa Najafi ³ , Ziba Zohourian ⁴

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Received: 2017-06-06 Accepted : 2017-06-06 Published : 2013-05-22

Keywords: pain, paracetamol- caesarian – section,

Abstract :

Background and aims: postoperative analgesia is one of the most concerns of anesthesiologist and patients. Systemic opioids administration is the gold standard in reducing the severe pain after surgery but some side effects prevent the use of adequate doses of opioids. The aim of this study was evaluation the effect of intravenous paracetamol at the end of caesarian section procedure on postoperative pain. Methods: in this case-control clinical trial, 60 women condidate for caesarian section (ASA I-II) were enrolled. They randomely allocated in two groups for postoperative pain (n=30), one group received 1 gr paracetamol attenuated in normal saline, infused per 20 minutes at the end 20 minutes of surgery and 6 hours later and control group. Recieved nothing. Pain severity was evaluated exactly then, 1,3,6 hours after surgery, by visual analog scale. Results: mean age and weight of mothers was 26.7±5.2 years and 73.2±8 kg respectively. 55% of mothers were nuliparity and others were multipar. There was no differences between two groups considering age, weight, pariety, paracetamol caused no significant effect on blood pressure (systolic and diastolic)and heart rate. Also although there was a significant trend in pain severity in both groups, there was no significant difference between two groups (p>0.05). Conclusion: As there was no significant effect on sever postoperative pain using intervenous paracetamol , future studies on th effect of that on mild to intermediate pain is suggested.  

References:

 

1. Solt I, Melcer A, Yehieli I, Ophir E, Bornstein J. The treatment of post partum pain: survey of 26 maternity departments in Israel.Harefuah. 2009 Jul;148(7):427-431, 477, 476.


2. Pergolizzi JV, Raffa RB, Tallarida R, Taylor R, Labhsetwar SA. Continuous Multimechanistic Postoperative Analgesia: A Rationale for Transitioning from Intravenous Acetaminophen and Opioids to Oral Formulations.PainPract. Pain Pract. 2012 Feb;12(2):159-73.


3. Eldor J, Postoperative wound analgesia:A renewed modality?The journal of new York school of regional anesthesia. July 2009; Volume 13 : 11_19.


4. Smith HS. Perioperative intravenous acetaminophen and NSAIDs.Pain Med. 2011 Jun;12(6):961-81.


5. Fukuda K. Opioids. In: Miller's Anesthesia. 7^th ed. USA: Churchill Livingstone Elsevier; 2010. 769-824


6. رسولی مرجان ، تیموری فاطمه ، مرجع کامل داروهای ژنریک ایران همراه با اقدامات پرستاری ، دوم ، تهران ، اندیشه رفیع 1389؛ 5.


7. Nagda J,Bajwa  ZH. Definitions and classification of pain. In:Warfield CA, Bajwa ZH ,editors. Principles & practico of pain medicine. 2^nd ed.New York:Mc Graw Hill;2004.p. 145-187.


8. Davids NJH, Cashman  JN, Lee S. Synopsis of anesthesia.13^th edition. Philladelphia: Churchill Livingstone Elsevier; 2006.p.303-825.


9. Sarantopoulos C. Pain pathways and mechanisms. In : AbramSE,editor. Pain medicine: the requisites in anesthesiology. 1^st ed. St. Philadelphia: Mosby Elsevier; 2006.p 233-319.         


10.  Rahman HM, Beattie J. Managing Post Operative Pain. Pharma J 2005 july; 275(2): 145-9. 


11.  Scott jR, Gibbs Rs , karlan BY. Danforths obstetrics and gynecology. 9 ^th ed. Lipincott : Williams and Swilliams and Swilkins, 2003.chapter 24 :p.449-61.


12.  Melzack R ,wall p , Text book of pain management. 4 ^th ed. London: Churchill living stone ; 1999 .p.95-101


13. Mark A, Rosen C, Samuel C.Obstetrics. In: Stoelting RK, Miller RD.Basics of Anesthesia 5^th edition. Philadelphia: Livingstone Elsevier; 2007.p.475-503.


14. Kuan Y, smith s, miles c. Effectiveness of intra operative wound infiltration with long acting local anesthesia. ANZ J surg .2002 ;72 (1) :18-20.


15. Cuschieri A, Grace PA, Darzi A, Borley N, Rowley DT. Clinical Surgry. 2th ed.Massachusetts: Black well; 2003. P.303-331.


16. Sarantopoulos C. Apractical approach to post operative pain management. In: Abram SE, editor. Pain medicine: the requisites in anesthesiology. Philadelphia: Mosby Elsevier. 2006; P. 206-212.


17. Gomella LG,Haist SA, Adams AG, Smith   MK. Clinican’s pocket drug reference 2008. 1^st ed. St. New York: Mc Grew-Hill. 2008; P. 119-123.


18. Chandrasekharan NV, Dai H, Roos KL. Cox-3 a cyclo oxygenase-1 varient inhibited by acetaminophen and other analgesic antipyretic drugs. Proc Natl Acad Sci. 2002; 99(11): 1326-9.


19. Beck D, Schenk M. Rectal paracetamol has a significant morphine spring effect after hysterectomy. BJA. 2000 Oct; 85(4): 658-671.


20. Singh G. Gastrointestinal complications of prescription and over the counter NSAID. Am J Therapeut. 2000; 7(2): 63-77.


21. Stephan A, Schung DA. Effect of general anesthesia and surgery on the kinetics of intravenous proparacetamol. BJA. 1999 June; 82(Suppl 1): 121-125.


22. Pettersson PH,Jakobsson J,Owall A. Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. Cardiothorac Vasc Anesth. 2005 Jun; 19(3): 306-9.


23. Sinatra RS, Jahr JS, Reynolds L, Groudine SB, Royal MA, Breitmeyer JB, Viscusi ER. Intravenous acetaminophen for pain after major orthopedic surgery: an expanded analysis. Pain Pract. 2012 Jun;12(5):357-65. 


24.  Gunusen I, Karaman S, Acar A, Sargin A, Firat V. The efficacy of paracetamol versus tenoxicam on postoperative pain and morphine consumption after abdominal hysterectomy: a placebo-controlled, randomized study. Clin Exp Obstet Gynecol. 2012;39(1):49-52.


25. Mitra S, Khandelwal P, Sehgal A. Diclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean section. Acta Anaesthesiol Scand. 2012 Jul;56(6):706-11


26.  Silvanto M, Munsterhjelm E, Savolainen S, Tiainen P, Niemi T, Ylikorkala O, Scheinin H, Olkkola KT. Effect of 3 g of intravenous paracetamol on post-operative analgesia, platelet function and liver enzymes in patients undergoing tonsillectomy under local anaesthesia. Acta Anaesthesiol Scand. 2007 Oct;51(9):1147-54.


27.  Hynes D, McCarroll M, Hiesse-Provost O. Analgesic efficacy of parenteral paracetamol (propacetamol) and diclofenac in post-operative orthopaedic pain. Acta Anaesthesiol Scand. 2006 Mar;50(3):374-81.


28. Uysal HY, Takmaz SA, Yaman F, Baltaci B, Başar H. The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children. J Clin Anesth. 2011 Feb;23(1):53-7.


29. Kiliçaslan A, Tuncer S, Yüceaktaş A, Uyar M, Reisli R. The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations. Agri.2010 jan; 22(1): 7-12.


30. Munishankar B, Fettes P, Moore C, McLeod   GA. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. Int J Obstet Anesth. 2008 Jan;17(1):9-14.


31. Alhashemi JA, Alotaibi QA, Mashaat MS, Kaid TM, Mujallid RH, Kaki AM.Intravenous acetaminophen vs oral ibuprofen in combination with morphine PCIA after Cesarean delivery.Can J Anaesth. 2006 Dec;53(12):1200-6.


32. گودرزی مهرداد,ابراهیم سلطانی علیرضا,ملکی آناهید,دره شیری شهاب الدین,ضیایی فرد محسن. مقایسه اثر ضد دردی پروپاستامول با ترامادول. مجله دانشگاه علوم پزشکی مازندران (نامه دانشگاه). آذر و دی 1386; 17(61):81-87.


33. میرخشتی علیرضا,آریانی محمدرضا,دباغ علی,جباری مقدم مرتضی,رضوی سیدسجاد,الیاسی هدایت اله,محمدی توفیق آرش. مقایسه سولفات منیزیم و پاراستامول در بی دردی و تغییرات گازهای خونی وریدی طی بیهوشی موضعی داخل وریدی با لیدوکائین. بیهوشی و درد.  پاییز 1390; 2(5):27-34.


34.  حسنی ولی اله,منوچهری پور مهدی,مولوی نجومی مرضیه. بررسی تاثیر پاراستامول وریدی با دوزهای متفاوت بر مقدار تجویز اپیوئید حین و پس از اعمال جراحی اندام فوقانی. علوم پزشکی رازی (مجله دانشگاه علوم پزشکی ایران). بهار 1387; 15(58):109-115.


35.  مفیدی مانی,شاکر حسین,بصیرغفوری حامد. مقایسه اثر ضد دردی پروپاستامول با ترامادول. مجله دانشگاه علوم پزشکی مازندران (نامه دانشگاه). آذر و دی 1386; 17(61):81-87.

پرویزکاظمی آصف,غفاری سینا,امینی افشین,میرشمسی سیدمحمدحسین. کنترل درد به دنبال جراحی ارتوپدی در اندام تحتانی: مقایسه اثر پروستامول با مورفین. مجله جراحی استخوان و مفاصل ایران. پاییز 1384; 4(1 (مسلسل 13)):86-92