Pre-Emptive Effect of Intravenous Paracetamol Versus Intravenous Ketorolac on Post-Operative Pain and Shivering After Septoplasty Under General Anesthesia: A Comparative Study

Abstract

Objective: To observe the pre-emptive effect of intravenous paracetamol versus intravenous ketorolac in preventing postoperative shivering and pain after septoplasty in postoperative care unit.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Main Operation Theatre of Frontier Corps Hospital Quetta, from Sep to Dec 2019.
 Methodology: After ethical committee approval, 90 American Society of Anaesthesiologist (ASA-I patients, aged between 18-45 years, scheduled for septoplasty, were recruited and divided into three equal groups, Paracetamol (PA), Ketorolac (KE) and Placebo (PL) as per computer generated table. The paracetamol (PA) group (n=30) received 1gm intravenous paracetamol, ketorolac (KE) group (n=30) received 30mg intravenous ketorolac and group placebo (PL) received 100ml normal saline, 20 minutes before completion of surgery. Postoperative shivering and pain was assessed via four-point scale and visual analogue scale (VAS) respectively, in post-anesthesia care unit at 10 and 30 minutes post-extubation.
 Results: Mean visual analog scale (VAS) score in paracetamol group was 2.7 ± 1.41, ketorolac group was 2.3 ± 1.24 and in placebo group was 3.6 ± 1.44, with a p-value of 0.002. Mean four point shivering score in paracetamol group was 0.3 ± 0.55, ketorolac was 0.7 ± 0.78 and placebo group was 1.4 ± 1.00, with a p-value of <0.001.
 Conclusion: The effect of paracetamol is better than ketorolac in preventing pain and shivering after septoplasty under general anesthesia.

Efficacy of intravenous acetaminophen on postoperative shivering: A meta-analysis of randomized controlled trials

“…A low risk of the overall risk of bias for included 9 trials. [11][12][13][14][15][16][17][18] All 9 included trials provided a detailed description of randomization. The Cochrane Handbook for Systematic Reviews of Interventions was used to evaluate the risk of bias of the RCTs.…”

“…The Cochrane Handbook for Systematic Reviews of Interventions was used to evaluate the risk of bias of the RCTs. Eight studies [11,[13][14][15][16][17][18] were double-blinded. Four trials [11,13,17] reported allocation concealment.…”

“…Acetaminophen versus placebo on POS: 9 trials, [11][12][13][14][15][16][17][18] the incidence of POS (pooled RR 0.43, 95% CI: 0.35-0.52) in the acetaminophen group was significantly lower than that in the control group (Fig. 3), the reduction effect in severe shivering was also very significant (Fig.…”

“…Types of anesthesia: Acetaminophen significantly reduced the incidence of POS during both spinal anesthesia (pooled RR of 2 trials [12,16] : 0.18, 95% CI: 0.10–0.35) and general anesthesia procedure (pooled RR of 4 trials [13,15,18] : 0.57, 95% CI: 0.45–0.72) (Fig. 8).…”

Effect of timing of intraoperative administration of paracetamol on postoperative shivering: A randomised double-blind controlled trial

“…Administration of PCM towards the end of the surgery has been reported to have an anti-shivering effect in patients undergoing septoplasty[ 13 ] and during caesarean section under GA.[ 14 ] However, some researchers have also demonstrated PCM's efficacy after anaesthesia induction. [ 1 15 ] Kinjo et al .…”