Document Type : Original Article(s)
Authors
- Laleh Dehghanpisheh 1
- Fatane Jamshidi 1
- Saeid Khademi 1
- Shirin Farokhiani 1
- Mohammad Reza Cheraghi 2
- Mahsa Emadi 1
- Reza Kaboodkhani 3
- Naeimehossadat Asmarian 1
- Mahsa Banifatemi 1
1 Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
3 Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Effective pain management is crucial in septorhinoplasty and remains a significant challenge. This study investigated the effect of ketorolac and paracetamol on pain control in septorhinoplasty patients and assessed their efficacy in reducing the need for rescue analgesics.
Methods: This double-blind randomized clinical trial was conducted at Madar-Koodak Hospital (Shiraz, Iran), in 2022. Ninety-nine patients were randomly assigned to three groups to receive ketorolac 30 mg (n=33), paracetamol 1000 mg (n=33), and normal saline (n=33), respectively. All the medications were administered intravenously (IV) 30 min before surgery. The randomization procedure followed the block randomization method. If the pain did not subside, patients were also given a single dose of pethidine hydrochloride (25 mg). Pain intensity was measured using visual analog scale (VAS) 1 hour and 6 hours after surgery. The data were analyzed using SPSS software, using paired t tests, ANOVA, and Chi square tests.
Results: One-hour post-surgery, VAS scores in the ketorolac and paracetamol groups were significantly lower than in the placebo group (P<0.001). The mean difference with 95% CI for ketorolac-placebo and paracetamol-placebo was -0.57 (-0.94, -0.21), and -0.79 (-1.12, -0.45), respectively. The ketorolac and paracetamol groups required significantly less pethidine hydrochloride 1 hour post-surgery than the placebo group (P<0.001). The VAS scores and requiring pethidine were not significantly different between the ketorolac and paracetamol groups.
Conclusion: After septorhinoplasty, the administration of 1000 mg of IV paracetamol demonstrated comparable efficacy in pain reduction to 30 mg of ketorolac. It suggested that paracetamol could serve as a viable alternative to ketorolac in preventing postoperative pain after septorhinoplasty, particularly in patients for whom non-steroidal anti-inflammatory (NSAID) drugs could not be a suitable choice.
Trial registration number: IRCT20180922041084N6
Keywords
- Heppt W, Gubisch W. Septal surgery in rhinoplasty. Facial Plast Surg. 2011;27:167-78. doi: 10.1055/s-0030-1271297. PubMed PMID: 21404159.
- Szychta P, Antoszewski B. Assessment of early post-operative pain following septorhinoplasty. J Laryngol Otol. 2010;124:1194-9. doi: 10.1017/S0022215110001519. PubMed PMID: 20602848.
- Savoia G, Alampi D, Amantea B, Ambrosio F, Arcioni R, Berti M, et al. Postoperative pain treatment SIAARTI Recommendations 2010. Short version. Minerva Anestesiol. 2010;76:657-67. PubMed PMID: 20661210.
- Gadkaree SK, Shaye DA, Occhiogrosso J, Lee LN. Association Between Pain and Patient Satisfaction After Rhinoplasty. JAMA Facial Plast Surg. 2019;21:475-9. doi: 10.1001/jamafacial.2019.0808. PubMed PMID: 31536105; PubMed Central PMCID: PMCPMC6753502.
- Kehlet H, Wilkinson RC, Fischer HB, Camu F, Prospect Working G. PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007;21:149-59. doi: 10.1016/j.bpa.2006.12.001. PubMed PMID: 17489225.
- Neugebauer E, Sauerland S, Keck V, Simanski C, Witte J. [Surgical pain management. A Germany-wide survey including the effect of clinical guidelines]. Chirurg. 2003;74:235-8. doi: 10.1007/s00104-003-0615-9. PubMed PMID: 12647080.
- Rathmell JP, Wu CL, Sinatra RS, Ballantyne JC, Ginsberg B, Gordon DB, et al. Acute post-surgical pain management: a critical appraisal of current practice, December 2-4, 2005. Reg Anesth Pain Med. 2006;31:1-42. doi: 10.1016/j.rapm.2006.05.002. PubMed PMID: 16849098.
- Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, et al. American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005;165:1574-80. doi: 10.1001/archinte.165.14.1574. PubMed PMID: 16043674.
- Sclafani AP, Kim M, Kjaer K, Kacker A, Tabaee A. Postoperative pain and analgesic requirements after septoplasty and rhinoplasty. Laryngoscope. 2019;129:2020-5. doi: 10.1002/lary.27913. PubMed PMID: 30843623.
- Sommer M, Geurts JW, Stessel B, Kessels AG, Peters ML, Patijn J, et al. Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg. 2009;135:124-30. doi: 10.1001/archoto.2009.3. PubMed PMID: 19221238.
- Rosenquist RW, Rosenberg J, United States Veterans A. Postoperative pain guidelines. Reg Anesth Pain Med. 2003;28:279-88. doi: 10.1016/s1098-7339(03)00035-x. PubMed PMID: 12945020.
- Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth. 2001;48:1000-10. doi: 10.1007/BF03016591. PubMed PMID: 11698320.
- Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100:757-73. doi: 10.1213/01.ANE.0000144428.98767.0E. PubMed PMID: 15728066.
- Penprase B, Brunetto E, Dahmani E, Forthoffer JJ, Kapoor S. The efficacy of preemptive analgesia for postoperative pain control: a systematic review of the literature. AORN J. 2015;101:94-105. doi: 10.1016/j.aorn.2014.01.030. PubMed PMID: 25537330.
- Ahiskalioglu EO, Ahiskalioglu A, Aydin P, Yayik AM, Temiz A. Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine (Baltimore). 2017;96:e6200. doi: 10.1097/MD.0000000000006200. PubMed PMID: 28225506; PubMed Central PMCID: PMCPMC5569427.
- Aydil U, Yilmaz M, Akyildiz I, Bayazit Y, Keseroglu K, Ceylan A. Pain and safety in otorhinolaryngologic procedures under local anesthesia. J Otolaryngol Head Neck Surg. 2008;37:851-5. PubMed PMID: 19128715.
- Celik EC, Kara D, Koc E, Yayik AM. The comparison of single-dose preemptive intravenous ibuprofen and paracetamol on postoperative pain scores and opioid consumption after open septorhinoplasty: a randomized controlled study. Eur Arch Otorhinolaryngol. 2018;275:2259-63. doi: 10.1007/s00405-018-5065-6. PubMed PMID: 30022362.
- Alshehri AA. Comparative Evaluation of Postoperative Pain Scores and Opioid Consumption in Septorhinoplasty After Administration of Single-Dose Preemptive Paracetamol and Ibuprofen: A Randomized Controlled Trial. Int Arch Otorhinolaryngol. 2023;27:e471-e7. doi: 10.1055/s-0042-1749386. PubMed PMID: 37564463; PubMed Central PMCID: PMCPMC10411065.
- Ates I, Aydin ME, Ahiskalioglu A, Ahiskalioglu EO, Kaya Z, Gozeler MS. Postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty: a prospective, randomized, double-blind study. Eur Arch Otorhinolaryngol. 2020;277:1095-100. doi: 10.1007/s00405-020-05801-6. PubMed PMID: 31980886.
- Demirhan A, Akkaya A, Tekelioglu UY, Apuhan T, Bilgi M, Yurttas V, et al. Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty. Pain Res Treat. 2014;2014:850794. doi: 10.1155/2014/850794. PubMed PMID: 24876957; PubMed Central PMCID: PMCPMC4020296.
- Pourfakhr P, Khajavi MR, Jalali A, Memari F, Etezadi F, Momeni Roochi M, et al. Low-dose preoperative pregabalin improves postoperative pain management in septorhinoplasty surgery: a double-blind randomized clinical trial. Eur Arch Otorhinolaryngol. 2019;276:2243-9. doi: 10.1007/s00405-019-05448-y. PubMed PMID: 31055640.
- Mohammadi A, Yazdani Y, Nazari H, Choubsaz M, Azizi B, Nazari H, et al. The effect of a single 75 mg preoperative dose of pregabalin on postoperative pain in rhinoplasty: A double-blinded, placebo-controlled randomized clinical trial. J Craniomaxillofac Surg. 2020;48:875-9. doi: 10.1016/j.jcms.2020.03.006. PubMed PMID: 32741642.
- Koputan MH, Apan A, Oz G, Kose EA. The effects of tramadol and levobupivacaine infiltration on postoperative analgesia in functional endoscopic sinus surgery and septorhinoplasty. Balkan Med J. 2012;29:391-4. doi: 10.5152/balkanmedj.2012.027. PubMed PMID: 25207040; PubMed Central PMCID: PMCPMC4115885.
- Kilic K, Sakat MS, Sahin A, Ahiskalioglu EO, Altunok H. Efficacy of intravenous magnesium sulfate infusion on postoperative pain and quality of recovery for septorhinoplasty: a randomized controlled study. Acta Otolaryngol. 2023;143:979-83. doi: 10.1080/00016489.2023.2289584. PubMed PMID: 38108626.
- Nguyen BK, Yuhan BT, Folbe E, Eloy JA, Zuliani GF, Hsueh WD, et al. Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence-Based Review. Laryngoscope. 2019;129:E200-E12. doi: 10.1002/lary.27616. PubMed PMID: 30585326.
- Smith HS. Potential analgesic mechanisms of acetaminophen. Pain Physician. 2009;12:269-80. PubMed PMID: 19165309.
- Ghanem CI, Perez MJ, Manautou JE, Mottino AD. Acetaminophen from liver to brain: New insights into drug pharmacological action and toxicity. Pharmacol Res. 2016;109:119-31. doi: 10.1016/j.phrs.2016.02.020. PubMed PMID: 26921661; PubMed Central PMCID: PMCPMC4912877.
- Doleman B, Read D, Lund JN, Williams JP. Preventive Acetaminophen Reduces Postoperative Opioid Consumption, Vomiting, and Pain Scores After Surgery: Systematic Review and Meta-Analysis. Reg Anesth Pain Med. 2015;40:706-12. doi: 10.1097/AAP.0000000000000311. PubMed PMID: 26469366.
- Gillis JC, Brogden RN. Ketorolac. A reappraisal of its pharmacodynamic and pharmacokinetic properties and therapeutic use in pain management. Drugs. 1997;53:139-88. doi: 10.2165/00003495-199753010-00012. PubMed PMID: 9010653.
- Vacha ME, Huang W, Mando-Vandrick J. The role of subcutaneous ketorolac for pain management. Hosp Pharm. 2015;50:108-12. doi: 10.1310/hpj5002-108. PubMed PMID: 25717205; PubMed Central PMCID: PMCPMC4336012.
- Javaherforooshzadeh F, Abdalbeygi H, Janatmakan F, Gholizadeh B. Comparing the effects of ketorolac and Paracetamol on postoperative pain relief after coronary artery bypass graft surgery. A randomized clinical trial. J Cardiothorac Surg. 2020;15:80. doi: 10.1186/s13019-020-01125-y. PubMed PMID: 32393370; PubMed Central PMCID: PMCPMC7216617.
- Dastan F, Langari ZM, Salamzadeh J, Khalili A, Aqajani S, Jahangirifard A. A comparative study of the analgesic effects of intravenous ketorolac, paracetamol, and morphine in patients undergoing video-assisted thoracoscopic surgery: A double-blind, active-controlled, randomized clinical trial. Ann Card Anaesth. 2020;23:177-82. doi: 10.4103/aca.ACA_239_18. PubMed PMID: 32275032; PubMed Central PMCID: PMCPMC7336963.
- Jahangiri Fard A, Farzanegan B, Khalili A, Ebrahimi Ahmadabad N, Daneshvar Kakhaki A, Parsa T, et al. Paracetamol Instead of Ketorolac in Post-Video-Assisted Thoracic Surgery Pain Management: A Randomized Trial. Anesth Pain Med. 2016;6:e39175. doi: 10.5812/aapm.39175. PubMed PMID: 28975070; PubMed Central PMCID: PMCPMC5560568.
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