Ocena skuteczności dożylnej infuzji paracetamolu w leczeniu bólu pooperacyjnego we wczesnym okresie po zabiegach ginekologicznych

*Anna Fijałkowska¹, Katarzyna Trela-Stachurska², Tomasz Rechberger²

Summary
Background.Traditionally, perioperative analgesia has been based on opioids, despite their various side effects. Recently, non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol have become more frequently used for this purpose. We have assessed the usefulness of iv paracetamol for analgesia after gynaecological surgery.
Methods. 92 patients, aged 20-69 years, scheduled for laparotomy or laparoscopy, were allocated to two groups. Anaesthesia was induced with propofol and maintained with N₂O/O₂, sevoflurane, fentanyl and cisatracurium. 15 min before the end of anaesthesia, all patients received 1 g intravenous paracetamol and the same dose was repeated 6 hours after surgery. 5 mg morphine was given as a rescue drug when necessary. VAS and VAS-R scales were used for pain assessment. Additionally, heart rate, non-invasive blood pressure (NIBP), and the frequency of side effects (pain on injection, skin rash) were noted.
Results. The medium VAS score in the laparoscopy group was 5.5, compared to 4.0 in the laparoscopy group. Paracetamol analgesia was satisfactory in the paracetamol group. Only 16.3% of the laparoscopy patients required additional morphine, compared to 71.4% of patients undergoing laparotomy. NIBP was also higher in this group. No side effects were noted.
Discussion and conclusion. Paracetamol, a serotonin activator and inhibitor of cyclooxygenase III and nitric oxide, effectively limits opioid requirement after surgery. No side effects, excellent tolerance, and early onset of action make this drug especially suitable for postoperative analgesia when nociceptive reaction is limited. Larger operations require a multimodal approach.

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