Oral versus Intravenous Paracetamol for Perioperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy - A Randomised Double-Blind Controlled Trial

Abstract

BACKGROUND Paracetamol has been commonly used for perioperative pain management. The perceived benefits of IV paracetamol (PCM) over oral are few if oral PCM is given sometime before surgery. We wanted to compare the effects of oral and intravenous paracetamol on perioperative pain management in patients undergoing total abdominal hysterectomy under general anaesthesia. METHODS Sixty-four female patients of American Society of Anesthesiologists (ASA) I / II, in the age group of 18 - 70 years, weighing 40 - 80 Kg, undergoing total abdominal hysterectomy (TAH) were randomised using computer-generated random number table, into two groups. They received oral dispersible 1 g PCM tablets (group PO) at least 45 minutes prior to surgery or intravenous (IV) PCM 1 g (group PI) after induction of anaesthesia. VAS pain scores were recorded and rescue analgesia with tramadol was provided postoperatively. RESULTS The primary outcome measure, time to first rescue analgesic, was statistically similar in both groups. The secondary outcome measures i.e., pain scores, postoperative 24 hours tramadol requirements, patient satisfaction scores and complications were also comparable. CONCLUSIONS Considering the similar efficacy and side effect profile but a much lower cost of oral PCM, routine administration of oral PCM 45 minutes before induction of anaesthesia may be an acceptable alternative to routine intraoperative IV PCM infusion. KEY WORDS Paracetamol, Intravenous, Oral, VAS Pain Score, Analgesia