COMPARATIVE STUDY OF INTRAVENOUS PARACETAMOL AND INTRAVENOUS DICLOFENAC ANALGESIA WITH RESPECT TO EFFECT ON RENAL FUNCTION, BLEEDING TIME, AND CLOTTING TIME IN POST-OPERATIVE CASES UNDERGOING LSCS UNDER SPINAL ANESTHESIA

JULIE PHILIPOSE BABY; ASHWINI MOTICHAND SHAH

doi:10.22159/ajpcr.2024.v17i3.50702

Authors

JULIE PHILIPOSE BABY Department of Anesthesiology, Amala Institute of Medical Science, Thrissur, Kerala, India.
ASHWINI MOTICHAND SHAH Department of Anesthesiology, Amala Institute of Medical Science, Thrissur, Kerala, India.

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i3.50702

Keywords:

Post-operative analgesia, LSCS, Paracetamol, Diclofenac

Abstract

Objectives: The aims and objectives of the study are to compare paracetamol and diclofenac for post-operative analgesia, efficacy, and safety profiles in patients undergoing LSCS under spinal anesthesia.

Methods: Fifty-eight patients undergoing LSCS under spinal anesthesia were included in this study. Out of these 58 patients, 30 patients received paracetamol (Group P) and the remaining 28 patients received diclofenac (Group D). Post-operative pain was assessed using the Visual Analog Scale. Rescue analgesic used was buprenorphine intravenous at a dose of 1 mg/kg. Injection buprenorphine was given to the patient with a VAS score of more than three in addition to the routine dose of the study drug. Pre-operative and post-operative values of blood urea, serum creatinine, bleeding time, and clotting time were compared in both groups. p<0.05 were taken as statistically significant.

Results: The mean age of patients in both groups was found to be comparable with no statistically significant difference (p=0.3849). In post-operative period at 150, 180 min, and 210 min, Group P reported significantly higher pain scores as compared to Group D with p-values indicating statistical significance (p<0.05). The analysis of pre- and post-operative renal function tests, bleeding time, and clotting time showed that there was no significant difference in the pre- and post-operative renal function tests, bleeding time, and clotting time of the patients in Group P and Group D.

Conclusion: Intravenous diclofenac is found to have a superior analgesic effect as compared to intravenous paracetamol. Both paracetamol and diclofenac were found to have no significant side effects on renal functions, bleeding time, or clotting time.

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References

Meneilly Z, McCutcheon K. Deep vein thrombosis and caesarean section. J Perioper Pract 2013;23:17-21. doi: 10.1177/1750458913023001-202

Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 2011;5:395-410. doi: 10.4103/1658-354X.87270

Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: A practical guide. Healthcare (Basel) 2021;9:333. doi: 10.3390/healthcare9030333

Dahl JB, Nielsen RV, Wetterslev J, Nikolajsen L, Hamunen K, Kontinen VK, et al. Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: A topical review. Acta Anaesthesiol Scand 2014;58:1165-81. doi: 10.1111/aas.12382

Olateju SO, Adenekan AT, Olufolabi AJ, Owojuyigbe AM, Adetoye AO, Ajenifuja KO, et al. Pentazocine versus pentazocine with rectal diclofenac for postoperative pain relief after cesarean section-a double blind randomized placebo controlled trial in a low resource area. Middle East J Anaesthesiol 2016;23:443-8.

Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol 2020;180:114147. doi: 10.1016/j. bcp.2020.114147

Alhassani RY, Bagadood RM, Balubaid RN, Barno HI, Alahmadi MO, Ayoub NA. Drug therapies affecting renal function: An overview. Cureus 2021;13:e19924. doi: 10.7759/cureus.19924

Muñoz M, Stensballe J, Ducloy-Bouthors AS, Bonnet MP, De Robertis E, Fornet I, et al. Patient blood management in obstetrics: Prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus 2019;17:112-36. doi: 10.2450/2019.0245-18

Lewald H, Girard T. Analgesia after cesarean section-what is new? Curr Opin Anaesthesiol 2023;36:288-92. doi: 10.1097/ ACO.0000000000001259

Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, et al. Guidelines for postoperative care in cesarean delivery: Enhanced recovery after surgery (ERAS) society recommendations (part 3). Am J Obstet Gynecol 2019;221:247.e1-9. doi: 10.1016/j.ajog.2019.04.012

Freo U, Ruocco C, Valerio A, Scagnol I, Nisoli E. Paracetamol: A review of guideline recommendations. J Clin Med 2021;10:3420. doi: 10.3390/jcm10153420

Lucas GN, Leitão AC, Alencar RL, Xavier RM, Daher EF, da Silva Junior GB. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. J Bras Nefrol 2019;41:124-30. doi: 10.1590/2175-8239-JBN-2018-0107

Osojnik I, Kamenik M. The effect of diclofenac on bleeding, platelet function, and consumption of opioids following cardiac surgery. Braz J Cardiovasc Surg 2020;35:160-8. doi: 10.21470/1678-9741-2019-0283

Pal A, Biswas J, Mukhopadhyay P, Sanyal P, Dasgupta S, Das S. Diclofenac is more effective for post-operative analgesia in patients undergoing lower abdominal gynecological surgeries: A comparative study. Anesth Essays Res 2014;8:192-6. doi: 10.4103/0259-1162.134502

Shah UD, Dudhwala KN, Vakil MS. Prospective, double-blind randomized study of comparison of analgesic efficacy of parenteral paracetamol and diclofenac for postoperative pain relief. J Anaesthesiol Clin Pharmacol 2019;35:188-91. doi: 10.4103/joacp.JOACP_384_16

Yoganarasimha N, Raghavendra TR, Radha MK, Amitha S, Sridhar K. Comparison of Paracetamol infusion with Diclofenac infusion for perioperative analgesia. RRJMHS 2012;1:18-22.

Forrest JB, Camu F, Greer IA, Kehlet H, Abdalla M, Bonnet F, et al. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. Br J Anaesth 2002;88:227-33. doi: 10.1093/ bja/88.2.227

Kiliçaslan A, Tuncer S, Yüceaktaş A, Uyar M, Reisli R. Sezaryen cerrahisinde intravenöz parasetamolün postoperatif analjezi ve tramadol tüketimine etkisi [The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations]. Agri 2010;22:7-12.

Ozmete O, Bali C, Cok OY, Ergenoglu P, Ozyilkan NB, Akin S, et al. Preoperative paracetamol improves post-cesarean delivery pain management: A prospective, randomized, double-blind, placebo-controlled trial. J Clin Anesth 2016;33:51-7. doi: 10.1016/j. jclinane.2016.02.030

Kashif S, Hamid M. Efficacy of intravenous paracetamol on pressor response in patients undergoing cesarean section under general anesthesia. J Anaesthesiol Clin Pharmacol 2016;32:210-3. doi: 10.4103/0970-9185.173332