Postoperative analgesic effects of intravenous acetaminophen vs intramuscular meperidine in children undergoing ambulatory herniotomy

Rectal acetaminophen has limited analgesic efficacy due to delayed absorption and subtherapeutic plasma concentration. Oral acetaminophen is not appropriate in the immediate postoperative period, i.v acetaminophen overcomes these problems and could provide adequate analgesia as a sole agent. This randomized double-blind study compared the analgesic effects of i.v acetaminophen and i.m meperidine in pediatric patients undergoing ambulatory inguinal herniotomy. Sixty children scheduled for unilateral inguinal herniotomy were randomized to receive either acetaminophen 15 mg/kg i.v [acetaminophen group], or 1 mg/kg meperidine i.m [meperidine group]. Anesthesia was induced by sevoflurane inhalation and maintained by sevoflurane in 50% N2O and O[2] through laryngeal mask airway. Postoperatively, Objective pain score, Ramsay sedation score and Aldrete score were recorded every 5 minutes for 30 minutes. Nursing satisfaction for postoperative analgesia was recorded on a 10 - point scale. Parent satisfaction for postoperative analgesia and postoperative nausea and vomiting was recorded on 4-point scale. Patients in acetaminophen group showed significantly low sedation scores during recovery room observation period. Objective pain scores were similar in both groups, as well as patients who required rescue analgesia, [25% in both groups]. Patients in acetaminophen group achieved an Aldrete score of 10 earlier than meperidine group. Parent satisfaction scores for postoperative analgesia were similar in both groups while those for postoperative nausea and vomiting showed significantly higher satisfaction scores in acetaminophen group. I.V acetaminophen achieved adequate analgesia comparable to that of i.m meperidine with less sedation, earlier readiness for discharge from recovery room and possibly less postoperative nausea and vomiting

Analgesic effect of intraperitoneal methylprednisolone after laparoscopic cholecystectomy

This study was designed to compare the analgesic effect of intraperitoneal methylprednisolone alone or combined with bupivacaine to intraperitoneal bupivacaine alone in female patients undergoing elective laparoscopic cholecystectomy. The study included 60 female patients undergoing elective laparoscopic cholecystectomy given a standardized general anaesthetic including fentanyl, propofol, N[2]O, isoflurane, and vecuronium. Patients were randomly allocated into one of three equal sized groups [n=20, each]. Group B: intraperitoneal 50ml bupivacaine 0.25% [125mg], group M: intraperitoneal 50 ml saline containing 125mg methylprednisolone, and group M+B: Intraperitoneal 50ml bupivacaine 0.25% [125mg] + 125mg methylprednisolone. The following parameters were evaluated in all patients: 1] Time to first request of analgesia [time elapsed between extubation and first analgesic dose], 2] The incidence and severity of postoperative shoulder and arm pain for 24 hours [the severity of postoperative shoulder and arm pain measured at 0, 6,12,18, and 24h postoperatively using VAS [0-10], 3] The amount of postoperative PCA morphine consumed in 0-6h, 6-12h, 12-18h, I8-24h, and 0-24h following extubation, and 4] Wound healing and infection. Times to first request of analgesia using intravenous morphine in groups B, M, and M+B were 22 [2] min, 10 [1] min, and 23 [1] min respectively. It was significantly short in group M compared to the other 2 groups [p<0.05]. Doses of intravenous PCA morphine consumed at 0-6h, 6-12h, 12-18h, 18-24h, and 0-24h were significantly less in groups M and M+B compared to group B [p<0.05]. There was no significant difference between groups M and M+B. The incidence and severity of shoulder pain were less in group M and M+B compared to group B [p<0.05] with no significant difference between group M and M+B. No apparent adverse effect was seen upon wound healing and infection. Intraperitoneal instillation of methylprednisolone [125mg] alone or in combination with bupivacaine 0.25% [125mg] in female patients undergoing laparoscopic cholecystectomy significantly decreases the postoperative analgesic requirements of intravenous morphine and decreased the incidence of shoulder pain compared to intraperitoneal bupivacaine 0.25% [125mg] alone with no apparent adverse effects upon wound healing and infection