Effect of preoperative administration of intravenous paracetamol during cesarean surgery on hemodynamic variables relative to intubation, postoperative pain and neonatal apgar.

Selection of anesthetic drugs for cesarean section requires many considerations. Anesthetic drugs for this purpose must prevent hemodynamic stress due to tracheal intubation, while inducing neonatal complications. This study was conducted to determine the effects of paracetamol given before induction of anesthesia on cardiovascular responses to tracheal intubation and postoperative pain in the mother, and on neonatal Apgar score. This double-blind randomized placebo-controlled trial included 60 women in ASA I, without underlying diseases and fetal distress, who were candidates for elective cesarean section under general anesthesia. Patients were divided into two groups of 30 patients. Patients in the paracetamol group received 1 g intravenous (IV) paracetamol 20 min before the operation, while those in the placebo group received 1 cc normal saline at the same time. In both groups, anesthesia was induced by sodium thiopental and succinylcholine. Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured before and immediately upon induction of anesthesia, and at first and fifth minute after tracheal intubation. Neonatal effects were assessed by Apgar score. Postoperative pain was assessed by use of the visual analog scale (VAS). The dose of analgesic used and the time of the first analgesic request by patients postoperatively were recorded. The SBP, DBP, MAP and HR were controlled significantly better in paracetamol group than in placebo group (P < 0.05). The mean 1-min and 5-min Apgar scores of neonates did not differ between the groups. The VAS pain score was significantly lower in paracetamol group than in placebo group at all measuring times (P < 0.05). Also, paracetamol caused later first analgesic request and lower dose of analgesic needed to control pain postoperatively (P < 0.05). In conclusion, the results of our study suggested IV paracetamol to be an efficacious agent to decrease hemodynamic responses to tracheal intubation, while providing better postoperative pain management without considerable neonatal complications in women undergoing cesarean section in general anesthesia.