The impact of multimodal analgesia timing on postoperative pain in cesarean delivery. A prospective randomized study

Abstract

AIM: The issue of preemptive or preventive use of paracetamol still raises questions in terms of multimodal analgesia in cesarean delivery. A combination of paracetamol and opioid is commonly used for pain management after cesarean delivery. This study aims to compare postoperative pain level and analgesic consumption when using paracetamol at two different perioperative times in cesarean section.

MATERIAL AND METHODS: Sixty patients recruited for elective cesarean section under general anesthesia were included in this prospective study. Patients were randomly assigned to receive iv 1 g paracetamol 15 minutes before incision (Group PE) or after delivery of newborn (Group PV). Visual analog scale (VAS) values, 24-hour morphine consumption, additional analgesic requirement, side effects, and patient and surgeons’ satisfaction were recorded.

RESULTS: Demographic data and hemodynamic values of the patients were similar in both groups. There was no differences between groups in terms of VAS scores at rest and during movement, additional analgesic requirement during the postoperative 1st hour, and 24-hour total morphine consumption. There was no difference in side effects, and patient and surgeon satisfaction scores postoperatively.

CONCLUSIONS: Preemptive and preventive use of paracetamol provides the same quality of analgesia and opioid sparing effect without increasing the frequency of adverse effects.