Journal of Isfahan Medical School

Journal of Isfahan Medical School

Impact of Preemptive Methadone or Paracetamol in Controlling Pain after Lower Abdomen Surgery under General Anesthesia

Document Type : Original Article (s)

Authors
Gholamreza Khalili 1
Seyed Taghi Hashemi 2
Zakieh Abdollahi 3
1 Associate Professor, Department of Anesthesiology, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v35i461.8877
Abstract
Background: The aim of this study was to evaluate the effect of preemptive methadone or paracetamol on postoperative pain in lower abdomen surgery under general anesthesia in comparison with control group.Methods: This was a randomized clinical trial study on 96 patients undergoing lower abdominal surgery. The subjects were divided into three groups. In the first group, 15 mg intravenous paracetamol was injected gradually after anesthesia induction and before surgery. In the second group, 0.15 mg/kg intramuscular methadone was injected into patient's deltoid muscle before anesthesia induction. In the third group, same volume of normal saline was injected. Then, pain intensity were evaluated in all three groups in recovery and ward up to 24 hours using visual analog scale (VAS).Findings: Pain intensity at 30 minutes after the surgery in the paracetamol group with a mean of 0.73 ± 0.31 was significantly lower than methadone group with a mean of 2.53 ± 0.54; and in both groups received the drugs was significantly lower than control group with a mean of 2.97 ± 0.57 (P < 0.050 for all). In contrast, since 60 minutes after the surgery to discharge time and in the ward, after 4 to 24 hours, pain intensity did not differ significantly between the three groups (P > 0.050).Conclusion: According our results, preemptive methadone had a much better effect in controlling postoperative pain compared to preemptive paracetamol; however, complications of paracetamol were less than methadone. Finally, pain intensity was evaluated equal in two groups for up to 24 hours after the surgery.
Keywords
Methadone
Paracetamol
Pain
Abdomen Surgery
  1. Bonica JJ. The management of pain. Philadelphia, PA: Lea and Febiger; 1990. p. 461-80.
  2. Chrisopher L. Acute postoperative pain. In: Stoeiting RK, Miller RD, editors. Basics of anesthesia. 6th ed. Philadelphia, PA: Churchill Livingstone; 2000. p. 2729-62.
  3. Parviz Kazemi A, Ghafari S, Amini A, Mir Shamsi SMH. Postoperative pain management in lower extremity orthopaedic surgery (Comparison between morphine and propacetamol). Iran J Orthop Surg 2005; 4(1): 86-92. [In Persian].
  4. Beauregard L, Pomp A, Choiniere M. Severity and impact of pain after day-surgery. Can J Anaesth 1998; 45(4): 304-11.
  5. Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg 2014; 134(4 Suppl 2): 85S-93S.
  6. Bowdle TA, Even A, Shen DD, Swardstrom M. Methadone for the induction of anesthesia: plasma histamine concentration, arterial blood pressure, and heart rate. Anesth Analg 2004; 98(6): 1692-7, table.
  7. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Marymont JH, Shear T, et al. Intraoperative methadone for the prevention of postoperative pain: A randomized, double-blinded clinical trial in cardiac surgical patients. Survey of Anesthesiology 2016; 60(4): 140.
  8. Sinatra RS, Jahr JS, Reynolds L, Groudine SB, Royal MA, Breitmeyer JB, et al. Intravenous acetaminophen for pain after major orthopedic surgery: An expanded analysis. Pain Pract 2012; 12(5): 357-65.
  9. Kouchek M, Mansouri B, Mokhtari M, Goharani R, Miri MM, Sistanizad M. A comparative study of intravenous paracetamol and fentanyl for pain management in ICU. Iran J Pharm Res 2013; 12(1): 193-8.
  10. Inal M, Tuncay CF. Paracetamol infusion is better than I.V. meperidine infusion for postoperative analgesia after caesarean section. The Internet Journal of Anesthesiology 2006; 15(1): 1-6.
  11. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med 2010; 83(1): 11-25.
  12. Van Aken H, Thys L, Veekman L, Buerkle H. Assessing analgesia in single and repeated administrations of propacetamol for postoperative pain: comparison with morphine after dental surgery. Anesth Analg 2004; 98(1): 159-65, table.
  13. Binhas M, Decailliot F, Rezaiguia-Delclaux S, Suen P, Dumerat M, Francois V, et al. Comparative effect of intraoperative propacetamol versus placebo on morphine consumption after elective reduction mammoplasty under remifentanil-based anesthesia: a randomized control trial [ISRCTN71723173]. BMC Anesthesiol 2004; 4(1): 6.
  14. Gottschalk A, Durieux ME, Nemergut EC. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg 2011; 112(1): 218-23.
  15. Taravati SH, Sattari H, Khosravi M, Shabani M. Comparison of the effects of methadone and morphine on postoperative pain scale following thoracic surgery in opium addict patients. J Kerman Univ Med Sci 2013; 20(2): 138-45. [In Persian].
  16. Shahraki AD, Jabalameli M, Ghaedi S. Pain relief after cesarean section: Oral methadone vs. intramuscular pethidine. J Res Med Sci 2012; 17(2): 143-7.
  17. 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; 53(12): 1200-6.
  18. Inal M. Treatment of fever and pain with paracetamol infusion after caesarean section. Internet J Pain Symptom Control Palliat Care 2007; 6(1): 1-4.
  19. Ali M, Khan FA. Comparison of analgesic effect of tramadol alone and a combination of tramadol and paracetamol in day-care laparoscopic surgery. Eur J Anaesthesiol 2009; 26(6): 475-9.
  20. Khalili G, Salimianfard M, Zarehzadeh A. Comparison between paracetamol, piroxicam, their combination, and placebo in postoperative pain management of upper limb orthopedic surgery (a randomized double blind clinical trial). Adv Biomed Res 2016; 5: 114.
  21. Kilicaslan A, Tuncer S, Yuceaktas A, Uyar M, Reisli R. The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations. Agri 2010; 22(1): 7-12. [In Turkish].
  22. Kashefi P, Honarmand A, Safavi M. Effects of preemptive analgesia with celecoxib or acetaminophen on postoperative pain relief following lower extremity orthopedic surgery. Adv Biomed Res 2012; 1: 66.
  23. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002; 88(2): 199-214.
Journal of Isfahan Medical School
Volume 35, Issue 461 - Serial Number 461
November and December 2018
Pages 1845-1851

  • Receive Date 26 September 2017
  • Accept Date 06 April 2022