POSTOPERATIVE PAIN MANAGEMENT

Postoperative Pain Management



Postoperative pain management

Background

Adequacy of postoperative analgesia is one of the most important factors that determine early hospital discharge and patients' ability to resume their normal activities postoperatively. The optimal non-opioid analgesic technique for postoperative pain management would reduce pain and enhance patient satisfaction, and it also facilitates earlier mobilization and rehabilitation by reducing pain-related complications after surgery. The aim of this study was to evaluate the analgesic efficacy of intravenous paracetamol and parecoxib when used alone, or in combination.

Conclusion

Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately.

Introduction

Despite the availability of various therapeutic approaches to pain management and an improved understanding of pain pathophysiology, acute postoperative pain continues to be undertreated or treated ineffectively. Proper pain management is essential for the early recovery and rehabilitation especially after knee surgery. Recent evidence suggests that this goal can be best achieved by using a combination of pre-emptive techniques involving both centrally and peripherally acting analgesic drugs and devices (Aubrun, 2003, 3140.

Opioids are effective analgesics, but their usefulness is limited by side effects, such as nausea and vomiting, somnolence, constipation, and respiratory depression. Non- opioids (e.g., paracetamol, non-steroidal anti-inflammatory drugs NSAID, and local anaesthetics) have opioid sparing effects.

Cyclo-oxygenase (COX)-2 selective inhibitor drugs (coxibs) are thought to have beneficial effects on inflammation and pain with concomitant preservation of homeostatic function and reduction in the incidence of side effects as compared with nonselective NSAIDs. Parenteral formulations allow for intra-operative administration and may overcome the problem of bioavailability encountered with oral formulations within the preoperative setting. Parecoxib is the first injectable COX-2 selective inhibitor indicated for the treatment of acute postoperative pain. It is an inactive pro-drug that undergoes rapid amidehydrolysis in vivo to the pharmacologically active, highly specific inhibitor of cyclooxygenase-2 (COX-2) enzyme, valdecoxib. Parecoxib and valdecoxib were not found to increase the risk of cardiovascular adverse events after non-cardiac surgery (Beaussier, 2005, 1309).

Paracetamol (acetaminophen) is an effective and safe analgesic used worldwide to relieve mild to moderate pain in conditions such as headache, toothache, and arthritis. Acetaminophen and NSAIDs probably have different sites of action; their combined use may have additive or synergistic effect. The objective of this study was to compare the analgesic effect of parecoxib and intravenous paracetamol given separately or together on the early postoperative pain and to evaluate patients' satisfaction in patients undergoing ACL under general anaesthesia.

Methods

After obtaining institutional approval and informed written consent, a prospective, randomized,. Physical status patients, aged between 18 to 25 years patient called joyce came to recovery room after Right Distal osteotomy and bone graft, pt received with LMA, removed in recovery morphie given as prescribed, pain team informed, surgeon informed, 50mg morphine and pca oxycodone and i/v paracetamol 1gm and tramadol oral .Naloxan was prescribed, but was not needed. Prescribed, anti-emetic ondansetron 4mg given, intraoperative she was stable, stay in recovery for 5 ...