Abstract
Purpose
To compare the effects ofiv acetaminophen with those of oral ibuprofen with respect to postoperative pain control and morphine requirements in patients receiving morphine patient-controllediv analgesia (PCIA) after Cesarean delivery.
Methods
Forty-five term patients scheduled for Cesarean delivery were randomized to receive acetaminophen 1 giv every six hours plus oral placebo (group A) or ibuprofen 400 mgpo every six hours plusiv placebo (group I); the first dose of study drug was given 30 min preoperatively. Postoperatively, all patients received PCIA for 48 hr using morphine bolus dose 2 mgiv, lockout interval ten minutes, and no basal infusion. Visual analogue scale (VAS; 0 to 10) at rest and morphine requirements were recorded every hour for four hours then every four hours for a total of 48 hr postoperatively. Patient satisfaction was recorded on a ten-point scale (from 1 to 10) 48 hr postoperatively.
Results
Visual analogue scale scores decreased similarly in both groups over time, however, there were no differences between groups at any time during the study period (estimated marginal means: 1.4 ± SEM 0.2vs 1.9 ± SEM 0.2 for groups A and I, respectively,P = 0.124). Cumulative doses of postoperative morphine were 98 ± 37vs 93 ± 33 mg for groups A and I, respectively (P = 0.628). Patient satisfaction with analgesia was high in both groups (9 ± 1vs 9 ± 1,P = 0.93).
Conclusion
Intravenous acetaminophen is a reasonable alternative to oral ibuprofen as an adjunct to morphine patient-controlled analgesia after Cesarean delivery.
Résumé
Objectif
Comparer les effets de l’acétaminophène iv à ceux de l’ibuprofène par voie orale quant au soulagement de la douleur et à la consommation de morphine chez les patientes recevant de la morphine dans le cadre d’une analgésie iv contrôlée par le patient (AICP) après une césarienne.
Méthode
Quarante-quatre patientes se présentant pour une césarienne ont reçu, de façon aléatoire, soit de l’acétaminophène 1 g iv toutes les six heures plus un placebo (groupe A), soit de l’ibuprofène 400 mg po toutes les six heures plus un placebo iv (groupe I), la première dose étant donnée 30 min avant la chirurgie. Après la chirurgie, toutes les patientes ont bénéficié d’une AICP avec morphine pendant 48 h, à la dose de 2 mg iv, avec un intervalle d’interdiction de dix minutes et aucune perfusion continue. On a noté les échelles visuelles-analogiques de douleur (EVA; 0 à 10) au repos et les besoins en morphine toutes les heures pendant quatre heures, puis toutes les quatre heures pour un total de 48 h suivant la chirurgie. La satisfaction des patientes a été évaluée selon une échelle à dix niveaux (de 1 à 10) après 48 h.
Résultats
Les scores d’EVA ont diminué avec le temps de façon semblable dans les deux groupes. Toutefois, on n’a retrouvé de différences significatives entre les groupes à aucun moment (moyenne marginale estimée: 1,4 ± ETM 0,2 vs 1,9 ± ETM 0,2 pour les groupes A et I, respectivement, P = 0,124). Les doses cumulatives de morphine étaient de 98 ± 37 vs 93 ± 33 mg pour les groupes A and I, respectivement (P = 0,628). Le niveau de satisfaction était élevé dans les deux groupes (9 ± 1 vs 9 ± 1, P = 0,93).
Conclusion
L’acétaminophène par voie iv est une alternative acceptable à l’ibuprofène par voie orale comme adjuvant dans le cadre d’une analgésie à la morphine contrôlée par le patient.
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Supported by Departmental Research Fund and, in part, by Bristol Meyers Squibb, Saudi Arabia (supplier of the study drug).
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Alhashemi, J.A., Alotaibi, Q.A., Mashaat, M.S. et al. Intravenous acetaminophenvs oral ibuprofen in combination with morphine PCIA after Cesarean delivery. Can J Anesth 53, 1200–1206 (2006). https://doi.org/10.1007/BF03021581
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DOI: https://doi.org/10.1007/BF03021581