EFFICACY OF 1.2GRAM PARACETAMOL IN THE MULTIMODAL MANAGEMENT OF POSTCAESAREAN SECTION PAIN

Abstract

Adequate analgesia is important after Caesarean section because it is desirable for mothers to be energetic, ambulate, interact and care for the newborn. It also reduces the risk of thromboembolic event post operatively. Despite improvements in analgesic delivery, several studies showed that up to 80% of patients report moderate to severe pain after surgery. The approach to adequate post-caesarean pain treatment has been a trend away from monotherapy towards multimodal strategy. Multimodal strategy was evaluated in a randomized controlled trial to determine the efficacy and safety of bupivacaine/pethidine/paracetamol combination for pain treatment after caesarean section in our hospital. Approval was received from the Research and Ethics Committee of the hospital. Women scheduled for elective caesarean section consented to participate in the study. These patients were randomized to receive subarachnoid block with bupivacaine/pethidine and paracatamol or bupivacaine/pethidine and saline.
The blood pressure, pulse rate, oxygen saturation, ECG and body temperature of all patients were monitored using the Multi-parameter monitor. The pain scores of the patients were also monitored from time of administration of study medication up to 24 hours postoperatively. Time to first request for analgesia, pain score at 6 hour and at request for first analgesia, analgesic consumption, adverse effects, maternal satisfaction were documented.
Data analysis was done using SPSS version 16.0. Continuous variables were analyzed using unpaired student t-test and categorical data analyzed with Chi-square test, where appropriate. The level of significance was set at a probability of 5%.
A total of 112 women were randomized to receive bupivacaine/ pethidine/paracetamol or bupivacaine/pethidine/saline. There was no difference in the sociodemographic characteristics between the two groups. There was a significant difference in time to first request for analgesia between the paracetamol group (322.80 ± 66.00mins) compared to the control group( 242.40 ± 43.80mins; p = 0.002). The paracetmol group consumed less pentazocine than the saline group (109.82 ± 28.03mg vs
124 ± 32.30mg; p = 0.002). Hypotension was the most common intraoperative complication in the population studied 51(40.8%). Adverse effects in the postoperative period were few. Patients satisfaction was rated higher in the paracetamol group.
This study shows that paracetamol in combination with bupivacaine/pethidine spinal anaesthesia as a multimodal strategy is effective in the treatment of pain following Caesarean delivery with minimal side effects. It is recommended therefore, that this combination should be offered to women who delivered their newborn by Caesarean section.