Evaluation of the Effect of Preemptive Intravenous Paracetamol on Perioperative Pain in Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors

1 Associate Professor, Anesthesiology and Critical Care Research Center AND Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The most common method of pain control after coronary artery bypass graft surgery is utilization of opioids and non-steroidal anti-inflammatory drugs (NSAIDs). In this study, the authors investigated the analgesic effects of intravenous paracetamol, while aiming to minimalize systemic side effects.Methods: In this prospective, randomized and triple-blinded clinical trial, patients were studied in two groups: a control group (n = 42) and a group treated with paracetamol (n = 51). The paracetamol group received an intravenous injection of the drug 15 minutes before induction of anesthesia and then every 6 hours for 3 days, 1 g paracetamol in 50 ml normal saline was infused in 15 minute. In the control group, normal saline was used instead of paracetamol in all stages of study in the same volume.Findings: Reported pain severities during resting [after 24 (P = 0.002) hour] and deep breathing [after 12 (P = 0.001), 24 (P < 0.001) and 72 (P = 0.031) hour] were significantly lower in the paracetamol group. There was no significant difference between the two groups, in terms of the amount of opioid requirements during (P = 0.246) and after (P = 0.853) surgery.Conclusion: Preemptive and then continuous prescription and use of paracetamol after cardiac surgery improves the quality of postoperative pain control of opioids. However, the potency of paracetamol alone is not enough to reduce the required dose and the side effects of opioid and sedative drugs.

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  1. Sattari M, Baghdadchi ME, Kheyri M, Khakzadi H, Ozar MS. Study of patient pain management after heart surgery. Adv Pharm Bull 2013; 3(2): 373-7.
  2. Mansouri M, Bageri K, Noormohammadi E, Mirmohammadsadegi M, Mirdehgan A, Ahangaran AG. Randomized controlled trial of bilateral intrapleural block in cardiac surgery. Asian Cardiovasc Thorac Ann 2011; 19(2): 133-8.
  3. Fayaz MK, Abel RJ, Pugh SC, Hall JE, Djaiani G, Mecklenburgh JS. Opioid-sparing effects of diclofenac and paracetamol lead to improved outcomes after cardiac surgery. J Cardiothorac Vasc Anesth 2004; 18(6): 742-7.
  4. Cattabriga I, Pacini D, Lamazza G, Talarico F, Di BR, Grillone G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. Eur J Cardiothorac Surg 2007; 32(3): 527-31.
  5. Pettersson PH, Jakobsson J, Owall A. Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2005; 19(3): 306-9.
  6. Jahangiri FA, Babaee T, Alavi SM, Nasiri AA, Ghoreishi SM, Noori NM, et al. Intravenous patient-controlled remifentanil versus paracetamol in post-operative pain management in patients undergoing coronary artery bypass graft surgery. Anesth Pain Med 2014; 4(5): e19862.
  7. Choiniere M, Watt-Watson J, Victor JC, Baskett RJ, Bussieres JS, Carrier M, et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. CMAJ 2014; 186(7): E213-E223.
  8. Stuppy DJ. The Faces Pain Scale: reliability and validity with mature adults. Appl Nurs Res 1998; 11(2): 84-9.
  9. Vera P, Zapata L, Gich I, Mancebo J, Betbese AJ. Hemodynamic and antipyretic effects of paracetamol, metamizol and dexketoprofen in critical patients. Med Intensiva 2012; 36(9): 619-25. [In Spanish].