Comparative study of the analgesic profiles of a new intravenous paracetamol preparation, ketorolac, and their combination in day case otorhinolaryngologic surgeries

This study was done on 60 adult patients who had day case otorhinolarngologic surgeries. Patients were allocated into three groups, according to perioperative analgesic used: Group 1 [n =20] was given 30 mg ketorolac IV, Group 2 [n=20] was given a new solubilised paracetamol formulation [Perfalgan 10mg/mi] 1gm IV infusion, and Group 3 [n=20] was given 30mg ketorolac IV plus Perfalgan 1gm IV infusion. Analgesic profiles were evaluated using the sum of pain intensity difference after 6 and 12 hours of drug intake [SPID[6and12]], the total pain relief score after 6 and 12 hours of drug intake [TOTPAR[6and12]], global patient satisfactionwith pain control, and use of rescue analgesics. Surgeons' satisfaction with intraoperative bleeding and surgical field, in addition to bleeding time were also studied as indications of tolerability to the drugs. This study demonstrated no significant differences in pain scores between ketorolac and Perfalgan, while SPID[6and12] and TOTPAR[6and12] were significantly higher in the combination group [11.6 +/- 2.1 and 20.2 +/- 4.5, p=0.01 and 0.022 respectively for SPID[6and12] and 19.6 +/- 6.2 and 39.3 +/- 8.6, p=0.001 and 0.003 respectively for TOTPAR[6and12] indicating much less pain intensity and better pain relief with the combination. In addition, fewer patients in the combination group required rescue pethidine, while no significant difference was detected in the use of rescue pethidine between the other two groups. Fourteen patients in the combination group rated their satisfaction for the analgesic regimen as very good to excellent, while only one patient in the ketorolac group had a very good response, and none of the Perfalgan group had a very good to excellent response. Surgeons' satisfaction with intraoperative surgical bleeding and surgical field was satisfactory to excellent in all groups. In addition, postoperative bleeding times in all groups did not show any significant prolongation 12 hours after discharge from recovery room. This study has demonstrated that the use of a combination of paracetamol IV infusion in the new formulation known as 'Perfalgan' Ig and IV ketorolac 30mg for control of postoperative pain in day case otorhinologic surgeries was efficient and enough to avoid the use of additional narcotics, and had a better analgesic efficacy than either drug alone, without any significant side effects on intraoperative or postoperative surgical bleeding

efficacy of combined superficial and deep cervical plexus block for anterior cervical discectomy

Major neck surgeries are conventionally performed under general anesthesia, but recent evidence suggests that regional anesthesia is an effective adjuvant to general anesthesia. The present study was designed to assess the efficiency of combined unilateral superficial and deep cervical plexus blocks with general anesthesia in patients undergoing anterior cervical discectomy. 30 patients undergoing to do anterior cervical discectomy surgery were divided into two group, general anesthesia group [GA]; patient received general anesthesia alone, and combined group [GC]; patients received combined general anesthesia and superficial and deep cervical blockade. Measurements were obtained which include intraoperative haemodynamics, intra and postoperative analgesic efficacy and hormonal stress response. The number of patients requiring supplemental analgesic and muscle relaxant was lower in GC than GA group. The SBP and HR were significantly lower during intra and postoperative period in GC group than the base line and the other GA group. VAS was significantly lower in PACU in GC group than GA group but after 12 and 24 hours, there was no statistical difference between the two groups. The time of initial morphine administration was significantly longer in GC group then the GA group and the total morphine administration was significantly lower in GC group than in GA group. The blood glucose and cortisol level were statistically significantly higher postoperatively compared to the base line. But this increase was clinically insignificant. Our results show that unilateral superficial and deep cervical plexus block performed with a 0.5% ropivacaine significantly reduced intraoperative requirements of anesthetics and analgesics in patients undergoing anterior cervical discectomy. And, the Postoperative analgesics were significantly reduced in combined group than the general anesthesia group