Propacetamol Vs. Tramadol For Post-Operative Pain Management After Urologic Surgery

摘要

Paracetamol (acetaminophen) is a safe and effective analgesic that is used for relieving mild to moderate pain. Tramadol, a synthetic opioid of aminocyctohexanol group, is an analgesic with central effect and weak opioid agonistic properties. This drug is also effective on noradrenergic and serotonergic neurotransmission. The aim of this study was to compare the analgesic and side effects of Propacetamol (Prodafalgan?,UPSA, France) and Tramadol (Aburaihan Pharmaceutical, Iran) after urologic open surgeries. A total number of 40 surgical patients were prospectively randomized into two equal groups of 20 and were entered into single blinded clinical trial. Anesthesia protocol was similar for all patients. Pain intensity was measured based on a 4-point verbal rating scale (VRS). VRS was obtained before analgesic administration (T0) and at 0.5, 1.5, 3, 4.5, 6, 12, 18 and 24 hours. Patients received either Tramadol 100 mg IV or Propacetamol 2 gr IV at T0 and then 50 mg Tramadol or 1.5 gr Propacetamol at 6, 12, 18 and 24 hours if pain was present. Pain relief score was measured after 24 hours based on a 5 point scale. The results of this study showed that Propacetamol could be considered as a safe alternative post-operatively for pain management; however its use for severe pain management leads to inefficient pain control, necessitating supplementary analgesics. Introduction Paracetamol (acetaminophen) is a safe and effective analgesic that is used for relieving mild to moderate pain (1). Oral and rectal formulations of this drug are used as adjunct parts of balanced analgesic regimens peri operatively (2,3,4).Propacetamol is the water–soluble prodrug of paracetamol that can be used if increased efficacy or more rapid onset of action is desired. In the blood, this drug is easily broken to paracetamol and diethylglycin under the effect of plasma esterases (5).Each gram of Propacetamol is there for equal to 0.5 gram of paracetamol. The latter substance then passes the blood brain barrier easily, exerting its central analgesic effect (6,7). The tolerability of Propacetamol is almost similar to that of paracetamol. Acetaminophen, however, is most effective for mild to moderate pain. On the other hand, the use of opioids may some times be limited because of the concern regarding their side effects, especially respiratory depression. In this situation, Tramadol could be a suitable alternative. Tramadol, a synthetic opioid of aminocyctohexanol group, is an analgesic with central effect and weak opioid agonistic properties. This drug is also effective on noradrenergic and serotonergic neurotransmission (8). When administered intravenously, Tramadol has a potency which is equal to pethidine and 1/10 of morphine (9). In patients older than 1 year it is tolerated well and has no remarkable adverse effect on hemodynamic and respiratory profiles (10). The aim of this study was to compare the analgesic effect and side effects of Propacetamol (Prodafalgan?,UPSA, France) and Tramadol (Aburaihan Pharmaceutical, Iran) after urologic open surgeries. Material and Methods A total number of 40 patients were prospectively randomized into two equal groups of 20 and were entered into this singles blinded clinical trial. The study was approved by investigational review board at Tehran University of Medical Sciences.All the patients were informed about the trial, however they did not know which analgesic have been prescribed for them.Inclusion criteria were age ≥18 years, post–operative pain, uncomplicated anesthesia, ASA class I or II, consciousness which was required for co-operation and open urologic surgery with either abdominal or flank incision including open prostatectomy, RPLND, radical cystectomy, pyelolithotomy, pyeloplasty, nephrectomy and nephrolithotomy. Exclusion criteria were pregnancy or lactation, drug or alcohol abuse, known allergy to Tramadol or acetaminophen or any contraindications for opioids use, history of renal, hepatic or pulmonary