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Assessment of postoperative analgesia using intravenous paracetamol during first day following thyroid surgery for goiter

Rafał Ziółkowski, Adam Srebrzyński, Krzysztof Kaczka, Agnieszka Butwicka, Krzysztof Kuzdak, Lech Pomorski

Med Sci Tech 2008; 49(1): RA41-46

ID: 881592

Introduction: The aim of the study was to assess efficacy of intravenous paracetamol in postoperative pain management during first day post surgery in patients operated for multinodular goiter. Material and methods: Ninety patients operated for nontoxic (n= 56; 62.2%) or toxic (n=34; 37.8%) multinodular goiter were included in the study. The study population consisted of 69 (77%) females and 21 (23%) males, aged from 21 to 78 years. The patients were randomized to three groups. Group 1 received intravenous paracetamol 1.0 g every 6 hours post surgery. Group 2 received similar pain therapy egimen combined with injection of 10 ml 0.25% bupivacaine in postoperative wound margins. Group 3 received similar postoperative pain management regimen plus 1.0 g intravenous paracetamol before surgery (so-called preemptive analgesia). All patients were allowed to receive rescue 1 mg intravenous morphine as-needed . Pain intensity was assessed using 0-10 visual analogue scale (VAS) 6, 12, 18 and 24 hours post surgery. Results: In Group 1 mean pain intensity at 6, 12, 18 and 24 hours was 7, 7.5, 5 and 3.5, respectively; in Group 2 it was 6, 6, 3 and 2, respectively; and in Group 3 it was 4, 3, 2 and 1, respectively. Intravenous morphine 1 mg prn was administered to 11 (36.7%) patients in Group 1, 3 (10%) patients in Group 2 and no patient in Group 3. Conclusions 1. Pain intensity after thyroid surgery was highest in the first 12 hours post procedure..2 Paracetamol monotherapy with a first dose given postoperatively has not eliminated the pain effectively.3. Paracetamol combined with local anesthesia using 0.25% bupivacaine caused adequate decrease of postoperative pain. 4. Preemptive analgesia using intravenous paracetamol combined with local anesthesia decreased postoperative pain intensity and eliminated the need for opioid analgesics. (Clin Exp Med Lett 2008; 49(1):41-46)

Keywords: Goiter, Surgery, Pain, paracetamol

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