Pre emptive analgesia with iv paracetamol and iv diclofenac sodium in patients undergoing various surgical procedures: a comparative study

Abstract

To lay surgery is an every day occurance Although the motality due to surgical procedures have come down significantly, adverse effects such as pain, post operative nausea and vomiting are still common. Poorly control post operative pain can lead to serious complications. Aim of this study is to asses intra and post operative analgesic effects of i.v. paracetamol and i.v. diclofenac sodium used pre-emptively also to compare there hemodynamic effects. Meterial and method: Sixty patients undergoing various surgical procedures were included in the study. Patients were randomized in to two groups. In group I - i.v. paracetamol 1 gm. In 100 ml saline infusion was given over 15-20 mins, 30 min prior to induction of anesthesia. To start with, written concent was obtained and the patients were explained about he visual analogues score and pain severity score. Base line vital parameters like pulse rate, systolic and Diastolic B.P.. and Spo2 were recorded. The recommended drugs were given 30 min. prior to induction of anesthesia. 30 min. after giving the study drugs pre medication was given as inj. Glycol pyrolate 2mg. with inj. Midazolam 1 mg. i.v. to all the patients. Anesthaesia was induced with inj. Thiopentone sodium 5 mg/kg and inj. succinyl choline 2mg/ kg, after IPPV, airway was secured with appropriate sized cuffed endotracheal tube.Anesthesia was maintained wuth O2 *n20-50:50, vecuronium as a muscle relaxant and intermittent halothane. Pulse rate, SBP, DBP and Spo2 were recorded every 15 minitus during the procedure. At the end of surgery residual neuromuscular blocked was reversed with inj. Neostigmine methyl sulfate 2.5 mg. and inj. Glycopyrollate 5mg. After through oral suction and onset of spontaneous respiration with adequate muscle power, judged by head lift for 5 secs, Subsequently patients were assessed for pain relief. The assessment of post operative pain, in immediate post operative period i.e. in immediate post operative period, after the reversal when the patient was fully oriented and conscious enough to answer the question asked and further at 1 hour, 2 hours, 4 hours and 6 hours was made. The changes in pulse rate, SBP DBP and respiratory rate, SpO2 at different time periods were noted. For postoperative pain assessment, VAS and Pain Severity Score were used. The patient were given rescue drug when their pain severity score was 2 i.e when they themselves complained for pain and their visual analogue score was between 7-10 at this point, these patients were excluded from the futher comparison in the study the duration of analgesia was taken as the time between administration of analagesic drug and administration of rescue drug, Side effects, such as nausea, vomiting, respiration depression, itching, allergic reaction, stomach irritation, diarrhoea, and constipation, were cross-examined and recorded. Results : pain severity score should no significant difference among the two group while VAS also was similar in both the gps, Duration of analgesia was 4.27+ 1.26 hrs. in gp A while 4.86+1.55 hrs. in gp B. thus was stastistically significant. Conclusion: preemptive iv paracetamol is long acting and provides better analgesia than diclofenac with less sie effects.