Propacetamol in combination with intravenous patient-controlled analgesia for post cesarean section uterine contraction pain: A randomized controlled trial.

OBJECTIVES: Propacetamol, an intravenous prodrug of paracetamol, can be employed alongside intravenous patient-controlled analgesia (IVPCA) to decrease opioid consumption and associated side effects. While prior studies focused on propacetamol's efficacy in incisional wound pain, its effectiveness for uterine contraction pain remains underexplored.

MATERIALS AND METHODS: This prospective randomized controlled trial recruit parturients with ASA physical status class II, undergoing scheduled cesarean delivery at gestational age 36 weeks or greater. All parturients received spinal anesthesia and were randomly allocated to three groups: 0 g, 1 g and 2 g of propacetamol respectively in combination with morphine based IVPCA. The primary outcome was the postoperative visceral uterine contraction pain and wound incisional pain compared to 0 g group. The secondary outcomes comprised morphine consumption, patient satisfaction, and treatment-related adverse events. Hierarchical linear modeling and one-way ANOVA were used for statistical analysis.

RESULTS: A total of 97 parturients were enrolled. Both the 1 g and 2 g propacetamol groups showed significant reductions in incisional wound pain compared with the 0 g group (p = 0.001 and p < 0.001, respectively); however, only the 2 g of propacetamol significantly reduced uterine contraction pain (p = 0.002). Morphine consumption was lesser in 2 g propacetamol group (p < 0.001). Patient satisfaction and treatment-related adverse events did not differ among groups.

CONCLUSION: When combined with morphine-based patient-controlled analgesia, regular administration of 2 g propacetamol reduces uterine contraction pain and morphine consumption after cesarean delivery, whereas both 1 g and 2 g reduce incisional wound pain.