الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY ain is defined as “an unpleasant sensory and emotional experience of actual or potential tissue damage or an experience expressed in such terms” (Merskey and Bogduk, 1994). Pain is classified into three different types: inflammatory, neuropathic and dysfunctional pain (Basbaum et al., 2009; Woolf, 2010). Although this kind of classification schematizes and facilitates our clinical approach to treating pain, there is a large interindividual variability in the response of analgesics when administered to patients (Allegri et al., 2012). While there have been significant advancements in options for pain assessment and therapy, effective postoperative pain management remains a frequent dilemma for patients and clinicians (Diaz and Flood, 2006). Effective pain management improves patient satisfaction, decreases hospital stay, and shortens recovery of the postsurgical patient. The sequelae of inadequate postoperative pain management include: hospital re-admission, prolonged hospitalization, compromised prognosis, and increased morbidity secondary to immobility and pulmonary dysfunction (Carli et al., 2002). Management of acute pain after cesarean section has evolved considerably over the past decade. The general approach to pain after cesarean section is changing, shifting away from traditional opioid-based therapy. Typical analgesic regimens include opioids; nonopioid analgesics, such as paracetamol and NSAIDs, with the variable addition of local anesthetic techniques (Kuhnet, 2004). Paracetamol, known as acetaminophen in North America, is the most commonly prescribed analgesic for the treatment of acute pain (Sachs, 2005). Its major advantages over NSAIDs are its lack of interference with platelet function and safe administration in patients with a history of peptic ulcers or asthma (Hyllested et al., 2002). One out of four patients who receives 1 g of paracetamol achieves at least 50% pain relief (McNicol et al., 2011). The aim of this study is to compare the efficacy of intravenous infusion of paracetamol in comparison with meperidine (pethidine) as post caesarean section analgesia, as demonstrated by the degree of pain relief. The current study is a randomized controlled trial, which was conducted at Ain Shams university maternity hospital during the period from January to December 2013. A total of 680 pregnant women at full term pregnancy who were admitted for termination of pregnancy by cesarean section were recruited in the study, and were divided into 2 groups, 340 patients included in each group. Group A received 1000 mg paracetamol Summary -87- while group B received pethidine hydrochloride 1mg / Kg. post cesarean section pain was evaluated using VAS. There was no statistically significant difference between both groups as regards age, gestational age, parity and BMI. As regards vital data, the pulse rate was significantly lower in the pethidine group (84.3±5.18) as compared to paracetamol group (87.3±6.85) (p = 0.02). Systolic and diastolic blood pressure showed non significant difference between both groups. The mean VAS after 1 hour of receiving analgesia in the paracetamol group was 2.3±0.83 while in the pethidine group it was 2.2±0.76 and this was statistically significant (p = 0.045). The difference between both groups in VAS after 2, 3 and 4 hours was non significant (p > 0.05). The mean of mean VAS in the paracetamol group was 2.5±0.78 while in the pethidine group it was 2.4±0.72 and this was statistically non significant (p = 0.08). In the present study both paracetamol and pethidine showed good analgesic effect in post cesarean section pain management. Although in the paracetamol group VAS was significantly higher after 1 hr, the overall analgesic effect was good with non significant difference in the mean VAS over 4 hrs. It was declared in several studies that using paracetamol cause significant postoperative pain reduction (Remy et al., 2005; Davis et al., 2006; Kilicaslan et al., 2010; Akhavanakbari et al., 2013).As regards additional analgesia, it was needed in 26 (7.6%) patients in paracetamol group, while it was needed in 15 (4.4%) patients in pethidine group, and this difference was statistically non significant (p = 0.106). As regards side effects, in the pethidine group 4 (1.2%) patients had nausea and vomiting, 3 (0.9%) patients had hypotension and 1 (0.3%) patient had a decreased respiratory rate, while no side effects noticed in the paracetamol group, and this difference was statistically highly significant (p = 0.001). In a series of studies, it has been shown that the side effects of opioid in comparison with other drugs such as paracetamol and NSAID groups have had significant difference (Pluim et al., 1999; Pakar Tadbiri and Rahimi, 2001). |