Comparative Evaluation of Preoperative Administration of Single Dose Intravenous Paracetamol or Intravenous Diclofenac for Management of Postoperative Pain in Laparoscopic Cholecystectomy

Abstract

Background: Post-operative pain affects the patient’s operative outcome, well being and satisfaction from medical care. Pain is one of the most common causes of delay discharge in patient undergoing surgery. Paracetamol and diclofenac are the two non-opioid drugs that are being used in postoperative care in combination with opioids or alonewhere uses of opioids are contraindicated. Thus, present study conducted to compare efficacy of pre operatively administered single dose iv paracetamol or iv diclofenac for treatment of postoperative pain in laparoscopic cholecystectomy. Materials & Methods: A prospective interventional randomized comparative study was conducted in the department of Anaesthesiology, Critical Care and Preoperative Medicine, Hindu Rao Hospital and North Delhi Municipal Corporation Medical College, Delhi after obtaining approval of the ethical committee of the institution and written informed consent from all patients. In this study 64 Patients were randomly divided into two groups: Group P (n=32) and Group D (n=32) denoting Paracetamol and Diclofenac respectively. Test drugs were administered 30 minutes prior to induction and postoperative pain was evaluated using Visual Analogue Scale (VAS) score at 30 min, 1 h, 2 h, 3 h, 4 h, 8 h, 12 h, and 24 h (T13, T14, T15, T16, T17, T18, T19 and T20 respectively). Postoperative consumption of injection tramadol (2 mg/kg) i.v. was measured which was given as a rescue analgesic, whenever the patient complained of pain or VAS >3 or both, at any time after surgery within the first 24 hrs with a minimum duration of 4 hours between each dose. Results: Visual analogue scale (VAS) score was significantly lower in group P (paracetamol) as compared to group D (diclofenac) in the post-operative period at 30 min (T13: p=0.040), 1 hour (T14: p= 0.025), 3 hour (T16: p=0.018), 4 hour (T17: p<0.001), 8 hour (T18: p=0.007) which was statistically significant (p value<0.05).Total dose of recue analgesic consumed was significantly higher in group D as compared to group P (P=0.006).Time at which first dose of rescue analgesic required was significantly higher in group D as compared to group P (p=0.05). First dose of recue analgesic was required in group P at 4^th hour postoperatively as compared to diclofenac where first dose of recue analgesic was required at 1^st hour. Conclusion: We concluded that preemptive administration of intravenous paracetamol 1g/100 ml in patients undergoing laparoscopic cholecystectomy surgeries has better hemodynamic stability and provides more effective and longer duration of postoperative analgesia with decreased pain scores during postoperative period.