Comparison of the effects of intraoperative morphine, fentanyl or paracetamol administration on postoperative pain level and analgesic consumption in patients with synchronous intraoprative remifentanil infusion

Year 2020, Volume: 33 Issue: 2, 102 - 106, 31.05.2020

Cigdem Akyol Beyoglu Ercument Yentur

https://doi.org/10.5472/marumj.748638

Abstract

Objective: We aimed to compare the effects of morphine, fentanyl or paracetamol applied for anesthesia induction and at the end of
the surgery for postoperative pain control and analgesic consumption in patients who have undergone pelvic and lower abdominal
surgery.
Material and Methods: Patients with the American Society of Anesthesiologists (ASA) score I-II and aged between 18-70 years were
given intravenous remifentanil intraoperatively. Fentanyl was administered in doses of 1.5 mcg / kg during anesthesia induction and
10 min before the end of the surgery. In fentanyl group, morphine was administered in doses of 0.1 mg / kg during induction and 0.5
mg/kg 30 min before the end of the surgery and paracetamol was administered in doses of 10 mg/kg during induction and 5 mg/kg
30 min before the end of the surgery. Morphine was administered for patient-controlled analgesia.
Results: The mean verbal pain scores of the paracetamol group were significantly higher when compared to the pain scores of the
other groups at the 0, 1, 2, 3, 4, 8, 12, and 16 hours (p <0.01 , p = 0.02). Postoperative morphine consumption in the paracetamol
group was significantly higher (p = 0.02).
Conclusion: The addition of intraoperative paracetamol to the remifentanil infusion, may not be sufficient in postoperative analgesia
in gynecologic cancer surgery.

Keywords

Morphine, Paracetamol, Fentanyl, Postoperative pain

References

• [1] Flouvat B, Leneveu A, Fitoussi S, Delhotal-Landes B, Gendron A. Bioequivalence study comparing a new paracetamol solution for injection and propacetamol after single intravenous infusion in healthy subjects. Int J Clin Pharmacol Ther 2004;42:50-7. doi:10.5414/cpp42050
• [2] Lenz H. Raeder J, Hoymork SC. Administration of fentanyl before remifentanil-based anaesthesia has no influence on post-operative pain or analgesic consumption. Acta AnaesthesiolScand 2008; 52: 149-54. doi: 10.1111/j.1399- 6576.2007.01471.x
• [3] Motamed C, Merle JC, Yakhou L, et al. Postoperative pain scores and analgesic requirements after thyroid surgery: Comparison of three intraoperative opioid regimens. Int J Med Sci 2006;3:11-3. doi:10.7150/ijms.3.11
• [4] Kochs E, Cote D, Deruyck L, et al. Postoperative pain management and recovery after remifentanil-based anesthesia with isoflurane or propofol for major abdominal surgery. Br J Anaesth 2000; 84:169-73. doi:10.1093/ oxfordjournals.bja.a013398
• [5] Claxton RA, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg 1997; 84:509- 14.
• [6] Benson GD. Acetaminophen in chronic liver disease. Clin Pharmacol Ther 1983;33: 95-101. doi: 10.1038/clpt.1983.14
• [7] Toygar P, Akkaya T, Özkan D, Özel Ö, Uslu E, Gümüş H. Lomber diskektomi operasyonlarında i.v. parasetamolün preemptif analjezik etkisi var mı? Ağrı 2008;20:14-9.
• [8] Arıcı S, Gurbet A, Türker G. Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Ağrı 2009;21:54-61.
• [9] Jirarattanaphochai K, Jung S. Nonsteroidal anti-inflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlledtrials. J Neurosurg Spine 2008;9:22-31. doi: 10.3171/ SPI/2008/9/7/022.
• [10] Korkmaz DÖ, Tunalı Y, Cakmakkaya SÖ, et al. Efficacy of intravenous paracetamol, metamizol and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery. Eur J Anaesthesiol 2010; 27:428-32. doi:10.1097/ EJA.0b013e32833731a4.
• [11] Zhou TJ, Tang J, White PF. Propacetamol versus ketorolac for treatment of acute postoperative pain after total hip or knee replacement. Aneth Analg 2001;92:1569-75.
• [12] Van Aken H, Thys L, Veekman L, Buerkle H. Assessing analgesia in single and repeated administrations of propacetamol for postoperative pain: comparison with morphine after dental surgery. Anesth Analg 2004;98:159-65.
• [13] Varrasi G, Marinangeli F, Agro F, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg 1999;88:611-6.
• [14] Fard AJ, Babaee T, Alavi SM, et al. Intravenous patientcontrolled remifentanil versus paracetamol in post-operative pain management in patients undergoing coronary artery bypass graft surgery. Anesth Pain Med 2014 December; 4(5): e19862.
• [15] Claxton AR, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg 1997;84:509- 14.
• [16] Twersky SR, Jamerson B, Warner SD. Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. Journal of clinical anesthesia 2000;13:407-16. [17] Bowdle A T, Camprosei ME, Maysick L. A multicenter evaluation of remifentanil for early postoperative analgesia. Anesth Analg 1996;83:1292-7.
• [18] Huang PS, Gleason SM, Shah JA, Buros AF, Hoffman DA. Efficacy of intravenous acetaminophen for postoperative analgesia in primary total knee arthroplasty. J Arthroplasty 2018;33:1052-6. doi: 10.1016/j.arth.2017.10.054.