Comparison of IV Paracetamol with IV Opioid Analgesics in Management of Post-Operative Analgesia in Laparoscopic Cholecystectomy

Objective: To compare the efficacy of intravenous Paracetamol versus intravenous Tramadol in terms of post-operative analgesia in patients undergoing laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pak-Emirates Military Hospital (PEMH), Rawalpindi Pakistan, Jan 2020 to Feb 2021. Methodology: A total of 88 patients admitted for planned laparoscopic cholecystectomy were screened as per the selection criteria and were included in the study. They were further divided into two Groups. Each Group received 44 patients. Group-A received intravenous Paracetamol 1 g, while Group-B received intravenous Tramadol 100 mg, both given 6 hourly over 24 hours. Both Groups were evaluated for pain at regular interval via a Visual Analog Scale for pain, for the first 24 hours post-operatively. Results: Mean Visual Analog Scale score post-recovery at 0 minutes was 6.57±1.47 with Paracetamol and 6.84±1.39 with Tramadol, (p=0.38). The difference in both Groups remained non-significant when checked at regular intervals till 18 hours post-recovery where intravenous Paracetamol showed a clearly superior Visual Analog Scale score of 1.00±0.94 versus 1.66±1.06 with Tramadol, (p= 0.007). Thereafter, the difference disappeared again at 24 hours post-recovery. Conclusion: Paracetamol provides analgesia effectively when compared to Tramadol in the first 24-hour post-operative period. Moreover, it seems to be devoid of the adverse effect profile seen with opioid analgesics. Considering the results obtained, the routine use of Paracetamol as first-line analgesic post-operatively is highly recommended.