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Intravenous acetaminophen vs oral ibuprofen in combination with morphine PCIA after Cesarean delivery

[L’acétaminophène intraveineux vs l’ibuprofène par voie orale comme adjuvant de la morphine AICP après une césarienne]

From the Department of Anesthesia & Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Address correspondence to: Dr. Jamal A. Alhashemi, Department of Anesthesia & Critical Care, P.O. Box 31648, Jeddah 21418, Saudi Arabia. Fax: +966 2 6408015; E-mail: jalhashemi{at}kau.edu.sa

Purpose: To compare the effects of iv acetaminophen with those of oral ibuprofen with respect to postoperative pain control and morphine requirements in patients receiving morphine patient-controlled iv analgesia (PCIA) after Cesarean delivery.

Methods: Forty-five term patients scheduled for Cesarean delivery were randomized to receive acetaminophen 1 g iv every six hours plus oral placebo (group A) or ibuprofen 400 mg po every six hours plus iv placebo (group I); the first dose of study drug was given 30 min preoperatively. Postoperatively, all patients received PCIA for 48 hr using morphine bolus dose 2 mg iv, lockout interval ten minutes, and no basal infusion. Visual analogue scale (VAS; 0 to 10) at rest and morphine requirements were recorded every hour for four hours then every four hours for a total of 48 hr postoperatively. Patient satisfaction was recorded on a ten-point scale (from 1 to 10) 48 hr postoperatively.

Results: Visual analogue scale scores decreased similarly in both groups over time, however, there were no differences between groups at any time during the study period (estimated marginal means: 1.4 ± SEM 0.2 vs 1.9 ± SEM 0.2 for groups A and I, respectively, P = 0.124). Cumulative doses of postoperative morphine were 98 ± 37 vs 93 ± 33 mg for groups A and I, respectively (P = 0.628). Patient satisfaction with analgesia was high in both groups (9 ± 1 vs 9 ± 1, P = 0.93).

Conclusion: Intravenous acetaminophen is a reasonable alternative to oral ibuprofen as an adjunct to morphine patient-controlled analgesia after Cesarean delivery.

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