الفهرس 
Physiology of painOnly 14 pages are availabe for public view
 |  | from | 144 |  |  |
| | | from | 144 | | |
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).