Background and Goal of Study:
The addition of non-opioid analgesics to provide opioids
dose-sparing and reduce opioids related side effected has been
widely used in postoperative pain management. Paracetamol, a
conventional analgesic, is the most widely used drug for the
treatment of acute pain. Propacetamol is an intravenous
formulation of paracetamol prodrug. The study was aimed to
investigate the analgesic effect of propacetamol on post-cesarean
pain and epidural analgesics consumption within 48 hours.
Materials and Methods:
We performed a prospective, randomized, placebo-controlled
trial for single-dose of propacetamol as an adjuvant to patient
controlled epidural analgesia (PCEA) after elective cesarean
delivery. Sixty parturients undergoing epidural anesthesia for
cesarean delivery were randomized into two groups to receive
either intravenous 1 g paracetamol (5 mL) (Group P) or saline (5
mL) (Group C) immediately after the delivery of placenta. All
patients were provided with mixture of bupivacaine and fentanyl
solution via PCEA in the postoperative period. Primary outcome
was measured by pain intensity. Postoperative pain was
assessed by numeric rating scale (NRS) at postoperative care
unit (PACU), 2, 6, 24 and 48 hours postoperatively. The total
consumption of PCEA solution, rescue analgesics, muscle tone,
side effects and satisfaction were recorded and analyzed.Results and Discussion:
Patient characteristics were compared in Table 1. Painintensity in Group P was significantly lower compared to Group
C only within initial 2 hours(p=0.04) (Table 2). Total PCEA dose
consumption (PCEA solution contains bupivacaine 1mg and
fentanyl 1mcg per ml) and patients requested rescue analgesic
did not differ significantly between groups(p>0.05) (Figure 1).
There was no difference between groups with respect to muscle
tone, side effects and patient satisfaction (P>0.05) (Table 3).
Muscle tone was graded as: 3=No motor block, 2= Inability to
raise extended leg, able to move knees and feet, 1= Inability to
move leg and knee, able to move feet, 0=Complete motor block.
Conclusion:
The addition of single-bolus intravenous 1 g paracetamol to
PCEA reduced pain intensity only within 2 hours after cesarean
delivery but did not provide a PCEA dose-sparing effect during the first 48 hours.

01 / Single bolus propacetamol with patient-controlled epidural analgesia in post-cesarean pain control