Anesth Pain Med.  2017 Oct;12(4):326-334. 10.17085/apm.2017.12.4.326.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea. anji43@naver.com

Abstract

BACKGROUND
The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries.
METHODS
Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis.
RESULTS
There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time.
CONCLUSIONS
The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

Keyword

Analgesia; Ketorolac; Patient-controlled; Propacetamol

MeSH Terms

Analgesia
Analgesia, Patient-Controlled*
Blood Urea Nitrogen
Body Temperature
Dizziness
Female
Fentanyl
Gynecologic Surgical Procedures
Headache
Heart Rate
Hematocrit
Humans
International Normalized Ratio
Ketorolac*
Nausea
Pain, Postoperative*
Passive Cutaneous Anaphylaxis
Postoperative Care
Pruritus
Vital Signs
Vomiting
Fentanyl
Ketorolac

Figure

  • Fig. 1 Values are presented as the mean ± SE. Repeated measures ANOVA were performed. In addition, paired t-tests were performed repetitively for each time segment to compare changes in SBP, DBP, HR, and BT within a group. Group K: 180 mg of ketorolac mixed with fentanyl and ramosetron in the IV PCA, Group P: 10 g of propacetamol mixed with fentanyl and ramosetron in IV PCA. T0, T1, T2, T3, T4, T5: 0 min, 15 min, 30 min, 60 min, 12 h, and 24 h after PCA application. There was significant effect of time (P values are all < 0.001), but no significant difference between the groups (P = 0.325, 0.835, 0.346, and 0.524, respectively). *Indicates significant differences for the time intervals within the group K (P values for SBP changes: T0–T1 < 0.001, T1–T2 < 0.001, T2–T3 = 0.189, T3–T4 < 0.001, T4–T5 = 0.200. P values for DBP changes: T0–T1 < 0.001, T1–T2 = 0.301, T2–T3 = 0.211, T3–T4 < 0.001, T4–T5 = 0.472. P values for HR changes: T0–T1 < 0.001, T1–T2 = 0.008, T2–T3 = 0.045, T3–T4 < 0.001, T4–T5 = 0.952. P values for BT changes: T0–T1 = 0.022, T1–T2 = 0.031, T2–T3 < 0.001, T3–T4 = 0.061, T4–T5 = 0.244). †Indicates significant differences for the time intervals within the group P (P values for SBP changes: T0–T1 = 0.039, T1–T2 = 0.006, T2–T3 = 0.043, T3–T4 < 0.001, T4–T5 = 0.457. P values for DBP changes: T0–T1 < 0.001, T1–T2 = 0.468, T2–T3 = 0.863, T3–T4 < 0.001, T4–T5 = 0.333. P values for HR changes: T0–T1 < 0.001, T1–T2 = 0.152, T2–T3 = 0.005, T3–T4 = 0.013, T4–T5 = 0.615. P values for BT changes: T0–T1 = 0.001, T1–T2 = 0.013, T2–T3 < 0.001, T3–T4 = 0.015, T4–T5 = 0.756).

  • Fig. 2 Values are presented as the mean ± SE. Repeated measures ANOVA was performed. Group K: 180 mg of ketorolac mixed with fentanyl and ramosetron in IV PCA, Group P: 10 g of propacetamol mixed with fentanyl and ramosetron in IV PCA. T0, T1, T2, T3, T4, T5: 0 min, 15 min, 30 min, 60 min, 12 h, and 48 h after PCA application. There was significant effect of time (P < 0.001) but no significant difference between the groups (P = 0.382). *Indicates significant differences for the time intervals within the group K (P values for VAS changes: T0–T1 < 0.001, T1–T2 < 0.001, T2–T3 < 0.001, T3–T4 < 0.001, T4–T5 < 0.001). †Indicates significant differences for the time intervals within the group P (P values for VAS changes: T0–T1 < 0.001, T1–T2 = 0.002, T2–T3 < 0.001, T3–T4 < 0.001, T4–T5 < 0.001).

  • Fig. 3 Values are presented as number (%). Each colored-square represents a study subject and a square with the same color and number represents an identical individual. Fisher’s exact chi-square tests were performed. Group K: 180 mg of ketorolac mixed with fentanyl and ramosetron in IV PCA, Group P: 10 g of propacetamol mixed with fentanyl and ramosetron in IV PCA. T1, T2, T3, T4, T5: 15 min, 30 min, 60 min, 12 h, and 24 h after surgery. S/E: side effect. A total of 13 patients experienced side effects, three from group K and 10 from group P (five patients experienced more than one type of side effects). There were no significant differences in the development of nausea, vomiting, dizziness, and headache between the groups at each time segments. However, the overall development of nausea for 24 hours was significantly different between the groups (P = 0.002).


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