Comparison between Preventive Analgesia versus Postoperative Analgesia with Combined Paracetamol and Ketorolac in Laparoscopic Cholecystectomy
Keywords:
Preventive Analgesia, Postoperative Analgesia, Paracetamol, Ketorolac, CholecystectomyAbstract
Background:
Preventive analgesia refers to the use of medication or medical procedures that can effectively inhibit or block the painful response, with the goal of preventing the discomfort that typically occurs during a surgical treatment.
Objective:
To identify if there are differences in the control of postoperative pain when using preventive analgesia versus postoperative analgesia, managed with paracetamol + ketorolac in patients undergoing laparoscopic cholecystectomy elective.
Patients and method:
A Prospective controlled clinical trial included a sample of 70 patients randomly assigned into two groups (group 1 and 2) each included 35 patients to receive either preventive analgesia or paracetamol + ketorolac.
Results:
After 60 minutes, group 1 showed a significant reduction in the mean diastolic blood pressure of 4.2 mmHg, (P. value<0.05). A significant reduction in the mean numerical verbal scale of 0.71 point was also reported (P. value <0.05). The diastolic blood pressure at four hours indicated a mean difference of -3.5, with a significant p-value of 0.033. The incidence of nausea was less than that in group 2 (2.9% 8.6% ) respectively.
Conclusion: Significant differences in the postoperative pain control, since patients with a preventive analgesia scheme have less postoperative pain compared to those to whom it grants them an immediate postoperative analgesia scheme.
Downloads
References
Siegel R, Hohenstein S, Anders S, Strik M, Kuhlen R, Bollmann A. Access to surgery and quality of care for acute cholecystitis during the COVID-19 pandemic in 2020 and 2021—an analysis of 12,545 patients from a German-wide hospital network. Journal of Gastrointestinal Surgery. 2022 Jul 1;26(7):1462-71.
Málek J, Ševčík P, Bejšovec D, Gabrhelík T, Hnilicová M, Křikava I, Mixa V. Postoperative pain management. Prague, Czech Republic: Mladá fronta. 2017;1(1):102-11.
Covarrubias-Gómez A. El manejo del dolor agudo postoperatorio: una década de experiencias. Revista Mexicana de Anestesiología. 2013;36(S1):179-82.
Díaz-Heredia J, Loza E, Cebreiro I, Iban MR. Preventive analgesia in hip or knee arthroplasty: A systematic review. Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 2015 Mar 1;59(2):73-90.
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T et al. Guidelines on the management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17:131-157.
Gupta A, Jakobsson J. Acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective inhibitors: an update. Plastic and reconstructive surgery. 2014 Oct 1;134(4S-2):24S-31S.
Nir RR, Nahman-Averbuch H, Moont R. Preoperative preemptive drug administration for acute postoperative pain: a systematic review and meta-analysis. Eur J Pain. 2016;20:1025-1043.
Lee SK, Lee JL, Choy WS. Is multimodal analgesia as effective as postoperative patient-controlled analgesia following upper extremity surgery? Orthop Traumatol Surg Res. 2013;99:895-901.
Katz J, Clarke H, Setzer Z. Preventive analgesia: quo vadimus? Anesth Analg. 2011;113:1242-1253.
Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110:1170-1179.
