Article

The Efficacy of Intravenous Paracetamol Versus Tramadol for Postoperative Analgesia after Elective Surgery

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Abstract

Background: Pain is an unpleasant sensory or emotional experience usually occurs due to potential tissue damage associated with surgical trauma. Opioids and Non steroidal antiinflammatory drugs are commonly used to alleviate pain but both have their own limitations in clinical use. Objectives: This prospective randomized clinical trial was undertaken to evaluate the efficacy and quality of recovery with intravenous paracetamol versus tramadol for post operative analgesia after elective surgery. Material and Methods: 40 ASA I&II patients of age group 15-40 years scheduled for elective surgery under general anaesthesia were enrolled in the study. After premedication, patients were randomized into two groups. Following induction of general anaesthesia patients of group 1 [n=20] received 15mg/kg of IV paracetamol and group 2 [n=20] received 1.0 mg/kg of IV tramadol over 15 minutes. During measurements, modified hanallah pain observation scores, Aldret scores [readiness for discharge], Sedation scores and Time to first rescue analgesia were recorded every 5 minutes during the first 30 minutes, then every 10 minutes for the remaining 30 minutes of the PACUs stay and upto first 2 hours in the ward. Statistical Analysis was done using SPSS Software Ver. 17. Results: Results reveals there is statistically significant difference in mean postoperative observational pain score, aldret score and time to first rescue analgesia though the mean post operative nausea&vomiting incidence and sedation score between two groups are statistically non significant. Conclusion: Clinically intravenous paracetamol offers better analgesic benefits to the patients than that of tramadol and due to early recovery characterstics in paracetamol group, patients are discharged early in case of paracetamol group and thus are economically effective in day care surgeries.

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Article
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We studied the analgesic efficacy of tramadol 2 mg kg–1 for post‐operative analgesia after day‐case adenoidectomy in children aged 1–3 yr. Eighty children were allocated randomly to receive tramadol 2 mg kg–1 i.v. or placebo immediately after induction of anaesthesia. Anaesthesia was induced with alfentanil 10 µg kg–1 and propofol 4 mg kg–1 followed by mivacurium 0.2 mg kg–1 for tracheal intubation. Anaesthesia was continued with sevoflurane in nitrous oxide and oxygen. All children were given ibuprofen rectally at approximately 10 mg kg–1 before the start of surgery. Post‐operative pain and recovery assessments were performed by a nurse blinded to the analgesic treatment using the Aldrete recovery score, the pain/discomfort scale and measurement of recovery times. Rescue medication (pethidine in increments of 5 mg i.v.) was administered according to the pain scores. A post‐operative questionnaire was used to evaluate the need for analgesia at home up to 24 h after operation. Rescue analgesic at home was rectal or oral ibuprofen 125 mg. Children in the tramadol group required fewer pethidine doses than those in the placebo group (P=0.014). Forty‐five per cent of children receiving tramadol did not require post‐operative analgesia at all compared with 15% of children receiving placebo (P=0.003). Recovery times and the incidence of adverse effects were similar in the two groups in the recovery room and at home. The requirement for rectal ibuprofen at home did not differ between groups. Br J Anaesth 2001; 86: 572–5
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Tonsillectomy is commonly performed in children, but unfortunately it is associated with intense postoperative pain. The use and optimal timing of nonsteroidal anti-inflammatory drugs (e.g. ketoprofen) during tonsillectomy is controversial. We evaluated the safety and efficacy of ketoprofen in 109 children, aged 3-16 years, during and after tonsillectomy in 1998-2000. Standardized anaesthesia was used. Forty-seven children received ketoprofen 0.5 mg.kg-1 at induction (preketoprofen group) and 42 children after surgery (postketoprofen group), followed by continuous ketoprofen infusion of 3 mg.kg-1 over 24 h in both groups; 20 children received normal saline (placebo group). Oxycodone was used for rescue analgesia. Pre- and postketoprofen groups did not differ in experienced pain or in opioid consumption in the first 24 h after surgery; demonstrating that ketoprofen did not have a pre-emptive effect. Patients in the placebo group received 30 more oxycodone doses than did patients in the ketoprofen groups, but the difference was not significant (P=0.074). Two patients (5) in the postketoprofen group had postoperative bleeding at 4 h and 26 h, respectively. Both patients required electrocautery to stop bleeding. Neither the incidence nor the severity of adverse events differed between study groups. This study demonstrates that ketoprofen did not have a preemptive effect and, at the dose used, did not perform statistically significantly better than placebo.
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Article
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Article
More than 30% of all surgical activity for children in England and Wales is accounted for by routine ENT operations. There is known to be a high incidence of postoperative pain, nausea and vomiting following paediatric tonsillectomy with or without adenoidectomy. This prospective study examined the incidence of these complications in 100 children admitted for routine, elective day-case tonsillectomy, with or without adenoidectomy. The children were anaesthetised in accordance with our standard paediatric day-case protocol. The incidence of vomiting on the day of surgery was significantly less in the group anaesthetised in accordance with the protocol, compared to those in previously published studies. Postoperative pain was well controlled, with 88% of the children having minimal pain on the day of surgery, and reporting a pain score of 0-2. Modifying the anaesthetic care to a protocol designed to reduce postoperative pain, nausea and vomiting achieved measurable improvements in the recovery of this group following surgery. It has enabled us to evolve from a 100% inpatient stay for these operations to 98% day-case discharge rate, with minimal post anaesthetic or surgical morbidity. We describe the protocol and discuss the implications of implementing such a protocol for children undergoing these common operations.
Article
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