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The Assessment of Addition of Either Intravenous Paracetamol or Diclofenac Suppositories to Patient-Controlled Morphine Analgesia for Postgastrectomy Pain Control.

Bameshki A, Peivandi Yazdi A, Sheybani S, Rezaei Boroujerdi H, Taghavi Gilani M - Anesth Pain Med (2015)

Bottom Line: There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001).In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups.Nevertheless, the amount of opioids did not affect the incidence of complications.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT

Background: Major surgical procedures, such as gastrectomy, result in extensive postoperative pain, which can lead to increased morbidity, discomfort and dissatisfaction among the patients.

Objectives: The aim of this study was to evaluate the effect of adding diclofenac suppositories or intravenous paracetamol, on morphine consumption and on the quality of postgastrectomy pain control.

Patients and methods: This randomized double blinded clinical trial was carried out in 90 patients with gastric cancer, who were candidates for gastrectomy, which were divided into three similar groups. The patients were transferred to an intensive care unit after the operation and received patient-controlled analgesia (PCA) with morphine, morphine PCA plus intravenous paracetamol 1 g, every 6 hours, and morphine PCA plus diclofenac suppositories, 100 mg every 8 hours. The patients were evaluated for up to 24 hours after the operation for the severity of pain, alertness, and opioid complications.

Results: There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001). In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups.

Conclusions: In this study, intravenous paracetamol or diclofenac suppositories, administered for postgastrectomy pain control, decreased morphine consumption by almost 32% and also improved alertness. Nevertheless, the amount of opioids did not affect the incidence of complications.

No MeSH data available.


Related in: MedlinePlus

Consciousness State in the Three Groups1- Awake, 2- Sometimes wake up and then sleep, 3- Almost always sleeps, 4- Hardly wakes up. The P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004, respectively.
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fig23327: Consciousness State in the Three Groups1- Awake, 2- Sometimes wake up and then sleep, 3- Almost always sleeps, 4- Hardly wakes up. The P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004, respectively.

Mentions: Consciousness level of the patients was not significantly and clearly different in the three groups, in the first 4 hours after the surgery, in the ICU. However, it was significantly different after 4 hours among three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours, were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004, respectively). Figure 1 shows the difference between morphine group and the paracetamol and diclofenac groups, in terms of consciousness level.


The Assessment of Addition of Either Intravenous Paracetamol or Diclofenac Suppositories to Patient-Controlled Morphine Analgesia for Postgastrectomy Pain Control.

Bameshki A, Peivandi Yazdi A, Sheybani S, Rezaei Boroujerdi H, Taghavi Gilani M - Anesth Pain Med (2015)

Consciousness State in the Three Groups1- Awake, 2- Sometimes wake up and then sleep, 3- Almost always sleeps, 4- Hardly wakes up. The P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644315&req=5

fig23327: Consciousness State in the Three Groups1- Awake, 2- Sometimes wake up and then sleep, 3- Almost always sleeps, 4- Hardly wakes up. The P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004, respectively.
Mentions: Consciousness level of the patients was not significantly and clearly different in the three groups, in the first 4 hours after the surgery, in the ICU. However, it was significantly different after 4 hours among three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours, were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004, respectively). Figure 1 shows the difference between morphine group and the paracetamol and diclofenac groups, in terms of consciousness level.

Bottom Line: There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001).In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups.Nevertheless, the amount of opioids did not affect the incidence of complications.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT

Background: Major surgical procedures, such as gastrectomy, result in extensive postoperative pain, which can lead to increased morbidity, discomfort and dissatisfaction among the patients.

Objectives: The aim of this study was to evaluate the effect of adding diclofenac suppositories or intravenous paracetamol, on morphine consumption and on the quality of postgastrectomy pain control.

Patients and methods: This randomized double blinded clinical trial was carried out in 90 patients with gastric cancer, who were candidates for gastrectomy, which were divided into three similar groups. The patients were transferred to an intensive care unit after the operation and received patient-controlled analgesia (PCA) with morphine, morphine PCA plus intravenous paracetamol 1 g, every 6 hours, and morphine PCA plus diclofenac suppositories, 100 mg every 8 hours. The patients were evaluated for up to 24 hours after the operation for the severity of pain, alertness, and opioid complications.

Results: There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001). In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups.

Conclusions: In this study, intravenous paracetamol or diclofenac suppositories, administered for postgastrectomy pain control, decreased morphine consumption by almost 32% and also improved alertness. Nevertheless, the amount of opioids did not affect the incidence of complications.

No MeSH data available.


Related in: MedlinePlus