Rectal paracetamol has a significant morphine-sparing effect after hysterectomy

Abstract

We have evaluated the morphine-sparing effect of rectal paracetamol during the first 24 h after abdominal hysterectomy in a placebo-controlled, double-blind study. We studied 72 patients receiving patient-controlled analgesia (PCA) with i.v. morphine after a standardized anaesthetic, allocated randomly to receive rectal paracetamol 1.3 g, diclofenac 50 mg or placebo, after wound closure and at 8 and 16 h. Suppositories were blinded by the hospital pharmacy. Study violations excluded data from seven patients. Patient data, morphine doses during anaesthesia and recovery, and sedation and nausea scores were comparable. Mean morphine consumption during PCA was 35.0 (SD 20.4) mg, 32.7 (27.4) mg and 54.9 (28.3) mg in the paracetamol (n = 24), diclofenac (n = 20) and placebo (n = 21) groups, respectively (P < 0.05). Morphine sparing during PCA for paracetamol and diclofenac (36% vs 40% over 24 h) was significant from 4 h. Global scores of average pain over 24 h were lower after diclofenac compared with paracetamol (P < 0.01) and placebo (P = 0.08). We conclude that rectal paracetamol was an efficacious adjuvant analgesic after regular dosing.

Intravenous acetaminophenvs oral ibuprofen in combination with morphine PCIA after Cesarean delivery

“…Furthermore, the concomitant administration of morphine PCIA did not appear to have an effect on patients' level of sedation, which is in keeping with previous reports. 14 Patient satisfaction scores with postoperative analgesia were high in all study patients which suggests improved quality of postoperative analgesia in both study groups. These results are consistent with those reported by Varrassi et al 13 but are in direct contrast with those of Beaussier et al 15 who have reported decreased patient satisfaction with iv propacetamol when compared with iv parecoxib.…”

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

“…When used as an opioid adjunct, oral or rectal acetaminophen reduces pain intensity 41 and opioid consumption by up to 30%, 42 although several systematic reviews and meta-analyses have shown no concurrent reduction in opioid-related side effects. 43 The use of oral over rectal acetaminophen is preferred, as the absorption of rectal acetaminophen is erratic and may therefore result in variable analgesic efficacy.…”

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

“…Rectal diclofenac is widely used to treat acute postoperative pain in children [5]. Paracetamol is an analgesic recommended for routine postoperative pain management [6]. Rectal preparations of paracetamol are also available for use when oral delivery is inappropriate [6].…”

“…Paracetamol is an analgesic recommended for routine postoperative pain management [6]. Rectal preparations of paracetamol are also available for use when oral delivery is inappropriate [6]. NSAIDs and paracetamol have different mechanisms of action and their combination could be synergistic.…”

“…In clinical practice, NSAIDs and paracetamol are widely used together, but whether such a combination actually offers a significant improvement in analgesia is controversial [6]. In a recent study in children undergoing appendicectomy, paracetamol with diclofenac did not provide additional benefit compared with either drug alone.…”