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Eur J Cardiothorac Surg 2007;32:527-531. doi:10.1016/j.ejcts.2007.05.017
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial

^a Department of Anesthesia and Intensive Care, Sant’Orsola-Malpighi Hospital, University of Bologna, Italy
^b Department of Cardiac Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Italy
^c Department of Cardiology, Sant’Orsola-Malpighi Hospital, University of Bologna, Italy

Received 8 January 2007; received in revised form 22 May 2007; accepted 23 May 2007.

^_* Corresponding author. Address: Unità Operativa di Anestesia e Rianimazione G. Grillone, Azienda Ospedaliera Sant’Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. Tel.: +39 051 6363629; fax: +39 051 6364195. (Email: iolter.cattabriga{at}fastwebnet.it).

Background: Nonsteroidal anti-inflammatory drugs and opioids are routinely used after cardiac surgery in order to mitigate postoperative pain; however, these drugs are burdened by side effects. Tramadol and paracetamol are believed to be lacking in such side effects. The aim of this study was to examine the efficacy of intravenous paracetamol as an adjunctive analgesic to a tramadol-based background analgesia after cardiac surgery. Methods: A total of 113 patients participated in this single center, placebo-controlled, double-blind, randomized trial. Fifty-six patients were randomized to receive paracetamol and 57 to placebo. Intravenous study drug (1 g) was administered 15 min before the end of surgery and every 6 h for 72 h. Standard analgesia (tramadol) and anti-emetic prophylactic regimen (ondansetron) were available to both patient groups. Postoperative pain was evaluated by visual analog scale, and it was measured at rest and during a deep breath. A rescue dose of 2–5 mg of intravenous morphine was administered whenever the VAS score was greater than 3. Results: Baseline characteristics were equivalent between the two groups. At 12, 18, 24 h after the end of operation, patients who received paracetamol had significantly less pain at rest (p = 0.0041, 0.0039, 0.0044, respectively); after this time the two groups did not differ. During a deep breath the difference was significant only at 12 h (p = 0.0040). Paracetamol group required less cumulative morphine than placebo group (48 mg vs 97 mg) even if the difference did not reach statistical significance (p = 0.274). Conclusions: In patients undergoing cardiac surgery, intravenous paracetamol in combination with tramadol provides effective pain control.

Key Words: Postoperative pain • Analgesia • Cardiac surgery