Comparison of intravenous Acetaminophen and Morphine Sulfate for abdominal pain management in patients with acute abdomen
DOI:
https://doi.org/10.18203/2349-3933.ijam20194231Keywords:
Abdominal, Intravenous acetaminophen, Morphine sulphate, Pain, PatientsAbstract
Background: Pain management is a crucial component in the postoperative care of patient. Opioids, which have been the mainstay of postoperative pain control for some time, are being used less because of significant adverse effects. Recently Intravenous acetaminophen that is an analgesic and antipyretic drug is used for reducing postoperative pain. Our Objective in this study was to use intravenous acetaminophen as an analgesic and antipyretic drug with the least complications and more safe than intravenous opioids for comparison with the effects of intravenous morphine sulfate in patients with acute abdominal surgery referred to emergency department of Fatemi Hospital.
Methods: 120 patients with acute abdomen will be assigned into the study by randomized allocation. Demographic data, pain severity in admission to the emergency department and 30 minutes after injection, vital signs in admission, side effects, and clinical findings will record questionnaires. The pain level, tenderness and the rebound tenderness of the patients will determine by the Visual Analog scale. The subjects will be divided into two groups A and B randomly. The intravenous acetaminophen (15 mg/kg/100cc normal saline in the form of intravenous infusion for 30 minutes) will be administered for group (A) and intravenous morphine sulphate (0.1 mg/kg Slow-acting intravenous injection for 1.5 to 2 minutes) will be administered for group (B). After 30, 60 and 90 minutes, the patient's pain is re-examined. Changes in the patient's pain, tenderness, rebound tenderness and side effects will documented in two groups and they will be compared. Finally, the collected data will be analyzed.
Results: The mean age of patients in acetaminophen group was 58.24±8.06 years with a mean age of 27-26 years and in morphine group was 56.7±7.63 years with age range of 34-69 years. There was no significant relationship between age and effect of intravenous acetaminophen and venous morphine sulphate (p=0.16). The mean of pain before injection of intravenous acetaminophen group was 8.92±1.25 and the mean pain before injection of morphine group was 8.80±1.35. There was no significant difference between the mean pain before injection of patients in the intravenous staphylococci group and the morphine group (p=0.049). The mean pain after injection of intravenous acetaminophen group was 4.46±1.25 and the mean pain after injection of the morphine group was 2.56±1.71. The mean pain after injection was significantly higher in patients with intravenous acetaminophen than in the morphine group (p<0.001).
Conclusion: Due to the effectiveness of morphine in relieving the pain of patients, it is recommended that doctors and associates use this painkiller to relieve pain in patients.
Metrics
References
Ankumah NAE, Tsao M, Hutchinson M, Pedroza C, Mehta J, Sibai BM, et al. Intravenous Acetaminophen versus Morphine for Analgesia in Labor: A Randomized Trial. American J Perinatol. 2017;34(1):38-43.
Milani GP, Benini F, Dell’Era L, Silvagni D, Podestà AF, Mancusi RL, et al. Acute pain management: acetaminophen and ibuprofen are often under-dosed. Eur J Pediatr. 2017;176(7):979-82.
Jalili M, Noori AM, Sedaghat M, Safaie A. Efficacy of intravenous paracetamol versus intravenous morphine in acute limb trauma. Trauma Mon. 2016; 21(1):117-25.
Sin B, Wai M, Tatunchak T, Motov SM. The use of intravenous acetaminophen for acute pain in the emergency department. Acad Emerg Med. 2016;23:(5)543-53.
Baley K, Michalov K, Kossick MA, McDowell M. Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review. AANA J. 2014;82(1):53-64.
Dela Cruz Ubaldo C, Hall NS, Le B. Postmarketing review of intravenous acetaminophen dosing based on Food and Drug Administration prescribing guidelines. Pharmacother. 2014;34(1):34-9.
Booth JL, Harris LC, Eisenach JC, Pan PH. A randomized controlled trial comparing two multimodal analgesic techniques in patients predicted to have severe pain after cesarean delivery. Anesth Analg. 2016;122(4)1114-9.
Pergolizzi JV, Taylor R, Raffa RB. The Potential Role of an Extended-Release, Abuse-Deterrent Oxycodone/Acetaminophen Fixed-Dose Combination Product for the Treatment of Acute Pain. Adv Ther. 2015;32(6):485-95.
Craig M, Jeavons R, Probert J, Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emer Medicine J. 2012;29(1):37-9.
Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab-tafti S, Reid D, et al. Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial. Pediatr. 2015;135(2):307-13.
Berthelot JM, Darrieutort-Lafitte C, Le Goff B, Maugars Y. Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs. Joint Bone Spine. 2015; 82(6):397-401.
Valentine AR, Carvalho B, Lazo TA, Riley ET. Scheduled acetaminophen with as-needed opioids compared to as-needed acetaminophen plus opioids for post-cesarean pain management. Int J Obstet Anesth. 2015;24(3):210-6.
Friedman BW, Dym AA, Davitt M, Holden L, Solorzano C, Esses D, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: A randomized clinical trial. J Am Med Assoc. 2015; 314(15):1572-80.
Aghamohammadi D, Gholipouri C, Hosseinzadeh H, Khajehee MA, Ghabili K, Golzari SE. An Evaluation of the Effect of Morphine on Abdominal Pain and PeritonealIrritation Signs in Patients with Acute Surgical Abdomen. Journal of cardiovascular and thoracic research. 2012;4(2):45-8.
Serinken M, Eken C, Turkcuer I, Elicabuk H, Uyanik E, Schultz CH. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial. Emerg Med J. 2012;29(11):902-5.
Morgan S. Intravenous paracetamol in patients with renal colic. Emerg Nurse. 2011;18(9):22-5.
McDaid C, Maund E, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess. 2010;14(17):1-153.
Babl FE, Theophilos T, Palmer GM. Is there a role for intravenous acetaminophen in pediatric emergency departments? Pediatr Emerg Care. 2011; 27(6):496-9.
Wininger SJ, Miller H, Minkowitz HS, Royal MA, Ang RY, Breitmeyer JB, et al. A randomized, double-blind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. Clin Ther. 2010; 32(14):2348-69.
Moon YE, Lee YK, Lee J, Moon DE. The effects of preoperative intravenous acetaminophen in patients undergoing abdominal hysterectomy. Arch Gynecol Obstet. 2011;284(6):1455-60.
Grissa MH, Claessens YE, Bouida W, Boubaker H, Boudhib L, Kerkeni W, et al. Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial. Am J Emerg Med. 2011;29(2):203-6.
