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Pain following cesarean delivery arises from multiple sources, including surgical incision and uterine contractions during postpartum recovery.
Adding 2 g propacetamol to intravenous patient-controlled analgesia (IVPCA) reduces uterine contraction pain and morphine consumption after cesarean delivery, while both 1 g and 2 g doses alleviate incisional wound pain.
Pain following cesarean delivery arises from multiple sources, including surgical incision and uterine contractions during postpartum recovery. Successful pain control is fundamental for maternal comfort, but opioid-based analgesia can trigger adverse effects and raise the burden of postoperative medication.
Propacetamol, an intravenous prodrug of paracetamol, may help improve postoperative analgesia while diminishing opioid requirements when combined with intravenous patient-controlled analgesia (IVPCA). However, its potency against visceral pain caused by uterine contractions has received less attention than its role in mitigating incisional wound pain.
This randomized controlled trial explored the effects of two propacetamol doses, administered alongside morphine-based IVPCA, on uterine contraction pain, incisional pain, morphine consumption, patient satisfaction, and treatment-linked adverse events following cesarean delivery.
This prospective study enrolled 97 pregnant women with American Society of Anesthesiologists (ASA) physical status class II who underwent scheduled cesarean delivery at a gestational age of 36 weeks or more. All subjects received spinal anesthesia and were randomly assigned to one of three groups as per the propacetamol dose administered with morphine-based IVPCA:
The primary outcomes were postoperative visceral pain linked with uterine contractions and incisional wound pain, compared with the control group. Secondary outcomes included morphine consumption, patient satisfaction, and treatment-related adverse events.
Among the 97 subjects, propacetamol illustrated benefits for postoperative pain alleviation following cesarean delivery. Compared with the control group, both the 1 g and 2 g propacetamol groups experienced remarkable reductions in incisional wound pain. However, only the 2 g dose reduced uterine contraction pain, indicating a dose-dependent benefit for this specific pain outcome.
Morphine consumption was also lower in the 2 g propacetamol group vs. the control group, suggesting a potential opioid-sparing benefit when propacetamol is combined with morphine-based IVPCA. However, patient satisfaction and treatment-related adverse events did not differ among the three groups.
Regular administration of 2 g propacetamol combined with morphine-based patient-controlled analgesia successfully targeted both post-cesarean uterine contraction pain and wound pain while decreasing total opioid needs. While lower doses (1 g) managed incisional pain, a 2 g dosage was essential for addressing visceral uterine contraction pain, improving post-delivery pain care without escalating treatment-related risks.
Taiwanese Journal of Obstetrics and Gynecology
Propacetamol in combination with intravenous patient-controlled analgesia for post cesarean section uterine contraction pain: A randomized controlled trial
Cheng Yeon Teong et al.
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