Cover Image

Comparison of the analgesic effects of Post-operative Morphine, Pre-emptive and Post-operative Paracetamol in Septorhinoplasty Surgery

Shoja-Al-hagh Taregh, Mohammad Reza Hadavi, Shahriyar Omidvari, Mohammad Ali Daneshforouz
Background: According to previous studies there are some different opinions on the pre-emptive effects of paracetamol in controlling post-operative pain, we aimed to compare the analgesic effects of pre-emptive paracetamol with post-operative paracetamol and morphine in patients undergoing septorhinoplasty.Materials and methods: A hundred and six patients aged 15 to 50 were divided into 3 groups. One received 1 g paracetamol 30 minutes before the operation, another group received 1 g paracetamol after the surgery and the control group received 3 mg morphine sulfate in the recovery room after the surgery. The pain severity was recorded for each patient using a 10 slot table. Any signs of nausea and vomiting (N/V) or apnea were closely observed and recorded. Patients with pain score 5 or more received 2 mg morphine intravascularly.Results: There was not any significant difference between the groups in total pain score and N/V (p>0.05). Post-operative morphine intake was significantly lower in pre-emptive group (P<0.05). None of the patients experienced apnea during the study. Conclusion: We concluded that pre-emptive paracetamol can lower the opium consumption in post-operative period but pre-emptive paracetamol cannot reduce the post-operative acute pain noticeably.
Paracetamol; Septorhinoplasty; pre-emptive analgesia; analgesics

Morrison RS, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ, et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103(3):303-11.

Lynch EP, Lazor MA, Gellis JE, Orav J, Goldman L, Marcantonio ER. Patient experience of pain after elective noncardiac surgery. Anesth Analg. 1997;85(1):117-23.

Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87(1):88-98.

Jenkins JT,O’Dwyer PJ.Inguinal hernias. BMJ. 2008;336(7638):269-72.

Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77-86.

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333.

Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3):409-23.

Walsh TD. Prevention of opioid side effects. J Pain Symptom Manage. 1990;5(6):362-7.

Dahl JB, Moiniche S Pre-emptive analgesia. Br Med Bull. 2004;71:13-27.

Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002;96(3):725-41.

McQuay HJ. Pre-emptive analgesia: a systematic review of clinical studies. Ann Med. 1995;27(2):249-56.

Malaise O, Bruyere O, Reginster JY. Intravenous paracetamol:a review of efficacy and safety in therapeutic use. Future Neurol. 2007;2(6):673-88

Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: new vistas of an old drug. CNS Drug Rev. 2006;12(3-4):250-75.

Duggan ST, Scott LJ. Intravenous paracetamol (acetaminophen). Drugs.2009; 69:101-13

Rettinger G, Kirsche H. Complications in septoplasty. Facial plastic surgery : FPS. 2006;22(4):289-97.

Campiglia L, Consales G, De Gaudio AR. Pre-emptive analgesia for postoperative pain control: a review. Clin Drug Investig. 2010;30 Suppl 2:15-26.

Arici S, Gurbet A, Turker G, Yavascaoglu B, Sahin S. Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Agri : Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology. 2009;21(2):54-61.

Joshi A, Parara E, Macfarlane TV. A double-blind randomised controlled clinical trial of the effect of preoperative ibuprofen, diclofenac, paracetamol with codeine and placebo tablets for relief of postoperative pain after removal of impacted third molars. The British journal of oral & maxillofacial surgery. 2004;42(4):299-306.

Romej M, Voepel-Lewis T, Merkel SI, Reynolds PI, Quinn P. Effect of preemptive acetaminophen on postoperative pain scores and oral fluid intake in pediatric tonsillectomy patients. AANA journal. 1996;64(6):535-40.


  • There are currently no refbacks.