Journal of Clinical Anesthesia (2016) 33, 51–57

Preoperative paracetamol improves post-cesarean

delivery pain management: a prospective, ran-
domized, double-blind, placebo-controlled trial
Ozlem Ozmete MD a,⁎,1 , Cagla Bali MD a,2 , Oya Yalcin Cok MD a,3 ,
Pinar Ergenoglu MD a,4 , Nesrin Bozdogan Ozyilkan MD a,5 , Sule Akin MD a,6 ,
Hakan Kalayci MD b,7 , Anis Aribogan MD a,8
a
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
b
Baskent University School of Medicine, Obstetrics and Gynecology Department, Adana, Turkey

Received 1 September 2015; revised 28 January 2016; accepted 18 February 2016

Keywords:
Abstract
Preoperative analgesia;
Study Objective: To evaluate the analgesic effect of preoperative single dose intravenous paracetamol on
Paracetamol;
postoperative pain and analgesic consumption within 24 hours after elective cesarean surgery.
Cesarean delivery;
Design: Prospective, randomized, double-blind, placebo-controlled clinical trial.
General anesthesia
Setting: University Teaching Hospital.
Patients: American Society of Anesthesiologists (ASA) I and II 60 patients between 18–40 years of age
who were scheduled to undergo elective cesarean section.
Interventions: Patients were randomized into two groups to receive either intravenous 1 g paracetamol
(100 mL) (Group P) or 0.9% NaCl solution (100 mL) (Group C) 15 minutes before the induction of general

⁎ Corresponding author. Tel.: +90 322 3272727x2461, +90 536 696 51 14 (mobile); fax: +90 322 3271273.
E-mail addresses: ozlemyilma@yahoo.com (O. Ozmete), caglaetike@hotmail.com (C. Bali), oyacok01@yahoo.com (O.Y. Cok), pergenoglu@yahoo.com
(P. Ergenoglu), nesrinbozdogan@yahoo.com (N.B. Ozyilkan), sakin00@yahoo.com (S. Akin), hakankalay78@gmail.com (H. Kalayci), aaribogan@yahoo.com
(A. Aribogan).
1
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi Dadaloglu, Mh.39. Sk. No.6 01250, Yuregir/Adana, Turkiye.
2
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi Dadaloglu, Mh.39. Sk. No.6 01250, Yuregir/Adana, Turkiye. Tel.: + 90 322
3272727x1472, +90 532 0613026 (mobile); fax: +90 322 3271273.
3
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi Dadaloglu, Mh.39. Sk. No.6 01250, Yuregir/Adana, Turkiye. Tel.: + 90 322
3272727x1469, +90 533 4306963 (mobile); fax: +90 322 3271273.
4
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi Dadaloglu, Mh.39. Sk. No.6 01250, Yuregir/Adana, Turkiye. Tel.: + 90 322
3272727x2467, +90 532 4725697 (mobile); fax: +90 322 3271273.
5
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi Dadaloglu, Mh.39. Sk. No.6 01250, Yuregir/Adana, Turkiye. Tel.: + 90 322
3272727x1106, +90 532 5837333 (mobile); fax: +90 322 3271273.
6
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi, Gazi Paşa Mah. Baraj Cad. No.7 01110, Seyhan/Adana, Turkiye. Tel.: +90 322
3272727x1156, +90 533 3584414 (mobile); fax: +90 322 3271273.
7
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi, Gazi Paşa Mah. Baraj Cad. No.7 01110, Seyhan/Adana, Turkiye. Tel.: +90 322
4586868x2110, +90 532 6740037 (mobile); fax: +90 322 4592622.
8
Baskent Universitesi Tip Fakultesi Adana Uygulama ve Arastirma Merkezi Dadaloglu, Mh. 39. Sk. No.6 01250, Yuregir/Adana, Turkıye. Tel.: + 90 322
3272727/2002, +90 532 2148661 (mobile); fax: +90 322 3271273.

http://dx.doi.org/10.1016/j.jclinane.2016.02.030
0952-8180/© 2016 Elsevier Inc. All rights reserved.
52 O. Ozmete et al.

anesthesia. After delivery of newborn 0.15 mg kg-1 morphine was administered to all patients in both
groups. Postoperative analgesia was provided with patient-controlled intravenous analgesia with morphine
in the postoperative period.
Measurements: Pain which is the primary outcome measure was assessed at 15th, 30th minutes and 1st,
2nd, 4th, 6th, 12th, 24th hours by the Visual Analogue Scale. Patients' demographics, hemodynamics,
Apgar score, additional analgesic requirement, side effects, patients' satisfaction and postoperative total
morphine consumption within 24 hours were recorded.
Main Results: Median visual analogue scale for pain in Group P was significantly lower compared to Group
C at all time points except for the score at 24th h postoperatively (P b .05). Additional analgesic requirement
during postoperative first hour was lower in Group P (P b .05). Total morphine consumption was higher in
Group C compared with Group P (P b .05). There was no difference between groups with respect to Apgar
scores, side effects, and patient satisfaction (P N .05).
Conclusions: Preoperative use of single-dose intravenous 1 g paracetamol was found to be effective in re-
ducing the severity of pain and opioid requirements within 24 hours after cesarean section.
© 2016 Elsevier Inc. All rights reserved.

1. Introduction 2. Materials and methods

Pain is the most common complaint of women having ce-
sarean deliveries [1]. Pain after a cesarean delivery blocks
the relationship between the mother, and newborn as well as
the care and feeding of the newborn. Furthermore, inadequate
pain management constitutes an important risk factor for post-
partum depression, and chronic pain development [2,3].
Spinal anesthesia is the preferred anesthesia method for
elective and emergency cesarean surgeries. However, general
anesthesia still has its place in patients with specific conditions
including coagulopathy, fetal distress, bleeding, eclampsia,
HELLP syndrome (hemolysis, elevated liver enzymes, and
low platelet count), and skin infections of the lumbar region
or the patient's unwillingness to receive regional methods.
Treatment modalities widely used for postoperative analge-
sia in patients undergoing general anesthesia include systemic
opioid administration (intramuscular or intravenous), oral-
rectal analgesics, and patient-controlled intravenous analgesia
(PCIA) methods. Non-opioids are commonly added to treat-
ments to increase analgesic efficacy and reduce opioid con-
sumption and opioid side effects. Adjuvant medications such
as paracetamol and non-steroidal anti-inflammatory drugs
(NSAID) are added to opioid therapy for this purpose.
Paracetamol is a non-opioid agent that affects the central
nervous system (CNS) primarily by inhibiting central cycloox-
ygenase (COX), and activating serotoninergic pathways via
the inhibition of nociceptive signal transmission in the spinal
cord [4].
This randomized, double-blind, placebo-controlled study
was conducted to evaluate the efficacy of preoperative IV
paracetamol to prevent and treat post-cesarean delivery pain.
We hypothesized that a single dose of IV paracetamol admin-
istered before general anesthesia would significantly reduce
acute postoperative pain, and provide less total morphine con-
sumption than the placebo over a 24-hour period.
The Baskent University Institutional Review Board and
Ethics Committee approved this prospective, randomized,
double-blind study (Project KA 13-180). The study was
supported by Baskent University Research Fund and
was completed over a period of 4 months. The protocol
for this clinical trial was registered at ClinicalTrials.gov
(NCT02369133).
Sixty pregnant women having an American Society of An-
esthesiologists (ASA) I and II between 18 and 40 years of age
who were scheduled to undergo an elective cesarean surgery
under general anesthesia were enrolled in this study. Inclusion
criteria included a single-fetus pregnancy, more than 38 weeks
of gestational age, refusal to have regional anesthesia during
cesarean section and being scheduled for an elective cesarean
section. The exclusion criteria included a body mass index
greater than 40 kg·m − 2 , being allergic to any of the study
drugs, psychiatric or cardiopulmonary diseases, chronic use
of analgesics, complications during the cesarean section, and
being unable to use a PCIA device.
2.1. Intervention
Preoperatively, all patients were informed about the study
parameters including pain management methods to be used
during the study including a visual analogue scale (VAS)
and the use of the PCIA device. Written informed consent
was obtained from all patients. All patients refrained from eat-
ing and drinking for 8 hours before surgery.
Patients were randomly divided into two groups by a closed
envelope method. A computer-generated table of random
numbers was obtained to randomly assign the patient into
one of the two groups. The assignment number was concealed
in closed envelopes until the patient was approved to enroll in
the study. These envelopes were prepared by an independent

anesthesiologist who was not associated with the study. The
envelopes were opened by the anesthesia technician who
also prepared the study drugs. The paracetamol group re-
ceived 1 g (100 mL) of paracetamol as an IV infusion 15 mi-
nutes before the induction of anesthesia (Group P, n = 30).
Participants in the control group received 0.9% NaCl solution
(100 mL) IV as a placebo 15 minute before the induction of
anesthesia (Group C, n = 30). The anesthesiologist who
performed the anesthesia, the participants, the care givers,
and those assessing the outcomes were all blinded to group
assignments.
In the operating room, standard monitoring with electrocar-
diography, pulse-oximetry and noninvasive blood pressure
were established. All patients enrolled in the study received a
standardized general anesthesia regimen. Metoclopramide hy-
drochloride and ranitidine hydrochloride were administered to
the patients intravenously and no other premedication was ad-
ministered before induction. After pre-oxygenation, induction
was performed, 2 mg kg-1 propofol and 0.5 mg kg-1 rocuro-
nium bromide were administered. Anesthesia was maintained
with 0.5% sevoflurane in 30% nitrous oxide in oxygen follow-
ing endotracheal intubation. The sevoflurane concentration
was increased to 1.5% and nitrous oxide was increased to
50% after delivery of the newborn. A 5 IU bolus of oxytocin
and 0.15 mg kg-1 morphine was administered to all patients
in both groups after the umbilical cord was clamped. No other
opioids or analgesics were administered intraoperatively. The
neuromuscular block was reversed with 0.03 mg kg-1 neostig-
mine and 0.01 mg kg-1 atropine at the end of the operation.
Hemodynamic variables including systolic and diastolic blood
pressures (SBP and DBP, respectively), mean arterial pressure
(MAP), heart rate (HR), and peripheral oxygen saturation
(SpO2) were recorded before induction, after induction, at in-
tubation, 5 minutes after intubation, and at 5-minute intervals
thereafter. All neonates were assessed by the same pediatrician
who was blinded to patient allocation. Apgar scores at 1 and
5 minutes were also recorded.
In the postanesthesia care unit (PACU), pain assessments
using by VAS were started in the immediate postoperative pe-
riod when the patients were fully oriented, and conscious
enough to answer questions. For postoperative pain relief, IV
morphine was initiated by PCIA (0.015 mg kg-1 bolus,
15 min lockout, no basal infusion, total dose of morphine
was limited to 0.24 mg kg− 1 4 h− 1) for all patients. When
the VAS scores were ≥ 3 at the postoperative period, the
PCIA was started. Patients received a 2 mg bolus of morphine
intravenously as additional analgesic when VAS was ≥ 4 de-
spite using PCIA. Each patient was kept in PACU for one hour
after surgery and evaluated there at the 15th and 30th minutes,
1st hour, and visited at the 2nd, 4th, 6th, 12th, and 24th hours
after surgery. These visits were to assess pain to confirm the
correct use of the PCIA and to evaluate the sedation levels
and side effects including respiratory depression, nausea,
vomiting, and presence of allergic reactions. During these
visits all postoperative assessments including additional
analgesic requirement, VAS score and total morphine
53
consumption were performed by an investigator anesthesiolo-
gist blinded to patient allocation and study drug. An anesthesia
technician blinded to the study recorded all the data. Postoper-
ative pain levels were evaluated by VAS (0 = no pain; 10 =
the worst pain possible) and recorded at the 15th and 30th
minutes, and the 1st, 2nd, 4th, 6th, 12th, and 24th hours
postoperatively.
Sedation levels were evaluated by using the Ramsey Seda-
tion Scale (1 = anxious and agitated; 2 = cooperative and
calm; 3 = drowsy but responsive to orders; 4 = asleep but re-
sponsive to a glabellar tap; 5 = sleeping and slowly responsive
to tactile stimuli; and 6 = patient unresponsive to painful stim-
uli). HR, SBP, DBP, and SpO2 were evaluated at the same
time points postoperatively. Postoperative adverse effects such
as nausea, vomiting, deep sedation, hypotension, bradycardia,
and respiratory depression were also recorded.
The same anesthesiologist who participated in the study
questioned the patients to evaluate their overall satisfaction
about pain relief for 24 hours postoperatively. All patients'
satisfaction levels were scored at the end of 24 hours after sur-
gery, as 1 = very satisfied, 2 = somewhat satisfied, 3 = some-
what dissatisfied, 4 = very dissatisfied who was involved.
2.2. Statistical analysis
The primary outcome parameter of this study was postoper-
ative pain scores evaluated by VAS. Power analysis of the
study was based on a study by Moon et al. [5]. Win-Epi 2.0
was used for the sample size calculation; a total of 60 patients
with 30 patients in each group were considered an appropriate
number following the sample size calculation for a 95% confi-
dence interval and a power of 80%.
The compact program SPSS 17.0 (SPSS Inc., Chicago, IL,
USA) was used for statistical analysis of the data. Categorical
variables were expressed as numbers and percentages, where-
as numerical variables were expressed as a mean and standard
deviation (and as a median and minimum–maximum, when
necessary). The intergroup comparison of numerical variables
was performed using Student t tests when the assumptions
were fulfilled, and Mann–Whitney U tests when the assump-
tions were not fulfilled. For parameters with a normal distribu-
tion, repeated measures analysis and the paired t tests were
used to compare dependent variables, whereas the Wilcoxon
test or the Friedman test were otherwise used. Pre-post mea-
sures data were analyzed with repeated measure ANOVA.
The Bonferroni correction was used to adjust the P value for
each hypothesis to .0056. Values of P b .0056 were consid-
ered statistically significant.
3. Results
Sixty-eight patients were screened for inclusion in the study
(Fig. 1). Eight patients were excluded (exclusion criteria [n = 5]
and refusal [n = 3]), leaving 60 patients for analysis. The
groups had similar demographics including age, weight,
54 O. Ozmete et al.

Enrollment

Assessed for eligibility (n = 68)

Excluded (n = 8)
♦ Not meeting inclusion criteria (n = 5)
♦ Declined to participate (n = 3)

Randomized (n = 60)

Allocation
Allocated to Paracetamol Group (n = 30) Allocated to Control Group (n = 30)
♦ Received paracetamol (n = 30) ♦ Received SF (n =30)
♦ Did not receive paracetamol (give reasons) (n=0) ♦ Did not receive SF (give reasons) (n=0)

Follow-Up
Lost to follow-up (give reasons) (n=0) Lost to follow-up (give reasons) (n = 0)

Discontinued paracetamol (give reasons) (n = 0) Discontinued SF (give reasons) (n = 0)

Analysis
Analysed (n = 30) Analysed (n = 30)
♦ Excluded from analysis (give reasons) (n = 0) ♦ Excluded from analysis (give reasons) (n = 0)

Fig. 1 Flow chart of the study design.

height, ASA status, gestational age, gravidity, parity and dura- points except for the score at 24th h postoperatively (Fig. 2).
tion of surgery (Table 1). There was a reduction in VAS scores in both groups at the
There were no significant intergroup differences identified postoperative 24 hour time. However, VAS scores of Group
with regard to MAP, HR, and SpO2 values between groups P were significantly lower than those of Group C during this
at the beginning of the operation, intraoperatively, and postop- time (Fig. 2).
eratively. None of the patients showed hypotension, hyperten- We determined that morphine consumption was significant-
sion, bradycardia or tachycardia. ly lower in the paracetamol-administered group compared to the
Median VAS scores were significantly lower in Group P control group when the groups were compared with respect to
compared with Group C at all measured postoperative time total morphine consumption during the 24 postoperative period,
the only exception was at the 30th minute (P = .084) (Fig. 3).
Postoperative morphine consumption during 24 hours was
24 mg (14–31 mg) in Group P versus 38 mg (26–46 mg) in
Table 1 Characteristics of study participants Group C (P b .000).
Group P Group C Since no patients in either group required additional analge-
Age (y) 28.07 ± 4.01 29.07 ± 5.67
sics after the first postoperative hour, we included the data of
Weight (kg) 77.67 ± 7.08 80.33 ± 9.67 the first hour in Table 2. When the groups were compared in
Height (cm) 163.0 ± 5.22 161.9 ± 4.33 terms of additional analgesic requirements during the first
ASA (I-II) 20/10 19/11 hour, additional analgesic consumption in Group C was higher
Gestational age (wk) 38.4 (38–40) 38.25 (38–39) compared to that observed in Group P (Table 2).
Gravidity 2 (1–6) 2 (1–5) Apgar scores were similar between groups and within
Parity 1 (0–4) 1 (0–2) normal ranges.
Duration of surgery(min) 34.67 ± 4.86 35.5 ± 5.92 Sedation and vomiting was not observed in both groups
Data are expressed as mean ± SD for age, weight, height and duration of whereas nausea was found in one patient in Group P and six
surgery, absolute numbers for ASA and medians (minimum-maximum) patient in Group C at 6th and 12th hours (p6h = 0.492; p12h =
for gestational age, gravidity, parity. 0.353). This was not statistically different between groups.
 55

Values are given as median (IQR)

* ; p = 0.000
; p = 0.003

Fig. 2 VAS differences among the groups.

The satisfaction level was high in both groups. However,
no significant difference was obtained between the groups
with respect to patient satisfaction (P = .543).
4. Discussion
In this study, we evaluated the efficacy of preoperative
paracetamol in patients who underwent cesarean sections with
general anesthesia. We found that the preoperative IV admin-
istration of a single dose of paracetamol significantly reduced
acute postoperative pain and resulted in less postoperative
opioid consumption over a 24-hour period. We also found that
additional analgesic requirements were significantly lower in
the paracetamol group compared with the control group in
the first postoperative hour.
The coadministration of opioids with non-opioids is widely
utilized to increase analgesic efficacy and to reduce opioid
consumption and opioid-related side effects for pain control
after cesarean sections [6,7]. Non-opioid drugs largely include
NSAIDs and in recent years, paracetamol. NSAIDs have been
shown to reduce pain caused by uterine cramping after cesar-
ean section and reducing opioid needs [1,8]. However, gastro-
intestinal side effects, thrombocyte dysfunction with the
associated prolongation of bleeding time and newborn

16
Grup P
Morphine Consumption (mg)

¶
14
Grup C
12
¶
10

8 ¶
6
¶
* ¶
4
*
2

0
0-15min 15-30min 30-60min 1-2 h 2-4 h 4-6 h 6-12 h 12-24 h
Postoperative Time

Fig. 3 Morphine consumptions of the patients during the given time intervals. Values are given as median (IQR) * P = 0.001, ¶ P = 0.000.
56
Table 2 Additional analgesic requirements of the patients in the
first hour after surgery
Group P Group C
p 30 min before the end of surgery. They found that preopera-
(n = 30) (n = 30)
PO 15. min, n (%) 2 (6.6%) 23 (76.6%) 0.000
PO 30. min 2 (6.7%) 13 (43.3%) 0.002
PO 1 hour 0 (0%) 6 (20%) 0.036
Data are presented as the number (%) of patients.
PO = postoperative.
pulmonary hypertension due to premature closure of the duc-
tus arteriosus secondary to prenatal use, limit the utilization
of NSAIDs in pregnant subjects [9]. There are also a few case
reports about uterus atonia following use of ketorolac and
diclofenac [10,11].
Paracetamol is widely used for analgesia and its antipyretic
effect in each of the three stages of pregnancy and during
breastfeeding [12]. The drug crosses the placenta [13] but its
safety in therapeutic doses for both the mother and fetus has
been established in the literature [14]. Its analgesic efficacy,
and safety have also been well demonstrated in various surgi-
cal procedures [15–17]. NSAID-associated complaints, such as
bleeding and dyspepsia are not observed after paracetamol use.
Furthermore, its availability in an IV form is an important feature
that provides ease of administration in general anesthesia practices.
Preemptive analgesia is a technique that provides a more ef-
fective postoperative pain control. It provides effective analge-
sia before the development of exogenous detrimental stimuli
by reducing peripheral sensitization and also by interrupting
the conduction of perioperative stimuli that are harmful to
the medulla spinalis [18]. Preemptive analgesia is also recom-
mended as a contemporary method in the treatment of postop-
erative pain. However, a common observation is that in a great
majority of the studies on pain management in cesarean sec-
tions, analgesic drugs are administered before the termination
of the operation or after the delivery of the newborn. In our
study, preoperative IV paracetamol was administered in cesar-
ean sections due to its applicability in pregnant subjects and
the availability of its IV form.
According to our knowledge, only a few studies have in-
vestigated preoperative paracetamol use for postoperative ce-
sarean section pain performed under general anesthesia. In
one of these studies, 60 patients were evaluated for the effect
of preoperative IV administration of paracetamol on hemody-
namic variables relative to intubation, postoperative pain, and
neonatal Apgar scores [19]. They suggested that IV paraceta-
mol is an efficacious agent to decrease hemodynamic re-
sponses to tracheal intubation while providing better
postoperative pain management without considerable neonatal
complications. Similarly, our study showed more effective
postoperative pain control and lower opioid consumption with
the use of preoperative paracetamol.
Hossam et al evaluated the effect of 1 g of preoperative IV
paracetamol versus preventive analgesia in elective cesarean
sections. Preventive analgesia is the method which means
O. Ozmete et al.
the intervention may or may not be initiated before surgery.
In this study, preoperative group recieved 1 g iv paracetamol
30 min before the surgery and preventive group received
tive paracetamol maintained better control of hemodynamic
variables from intubation time until delivery of the baby. They
also observed lower doses of intraoperative opioid require-
ments, longer times for the next needed analgesia, and lower
incidences of postoperative side-effects, but higher pain scores
in early postoperative periods and after 6 hours [20]. We think
that higher VAS scores in the first postoperative 6 hours in the
preemptive group is related to a greater amount of fentanyl use
in the preventive group during the intraoperative period. In
contrast with the previous two studies, we did not find any fa-
vorable effect in hemodynamic responses to tracheal intuba-
tion with 1 g of paracetamol when administered preemptively.
A previous study that randomized 80 patients undergoing
cesarean sections received 1 g of IV paracetamol and 75 mg
of intramuscular diclofenac either before the operation or at
the end of the surgery. Both groups received 3 μg kg-1 fenta-
nyl immediately after the delivery of the baby as a bolus dose.
They showed that the administration of paracetamol and diclo-
fenac combination preoperatively provides better analgesia, re-
duces pain scores, and reduced narcotic consumption in
patients [21].
Our study is consistent with other studies in the abdominal
surgery and gynecologic fields that demonstrate a reduction in
pain and narcotic usage after surgery with the administration
of preemptive paracetamol [5,22]. Studies conducted in two
different clinics on preemptive IV paracetamol use in total ab-
dominal hysterectomy operations revealed that the postopera-
tive pain scores, additional analgesic need and opioid use were
significantly reduced and an effective and safe analgesia was
achieved in the patients [5,22]. Our results are similar to those
reported above. Additionally, an assessment of 24-hour total
morphine consumption showed that it was 24 mg in the para-
cetamol group and 38 mg in the control group. An approxi-
mate 36% reduction in total morphine consumption was
achieved by a preoperative single dose of paracetamol, which
in our opinion is an important finding.
Opioid analgesic use is an important risk factor for postop-
erative sedation, nausea, vomiting, constipation, urinary reten-
tion, and itching. A reduction of systemic opioid usage would
be expected to reduce the incidence of these common side ef-
fects. In our study, the use of morphine was lower in the para-
cetamol group compared with the control group, but there was
no significant difference in the incidence of side effects be-
tween the groups. A possible explanation for these findings
might be that the sample size in our study was not large
enough to detect subtle differences. Our power analysis was
based on VAS but the number of patients may not have been
sufficiently large enough to detect side effects.
In our study, we found no adverse consequences associated
with intraoperative, and postoperative hemodynamic parame-
ters including MAP, HR, and SpO2. Also, no difference was
observed between the Apgar scores of the two group.

Patient satisfaction scores, which are directly related to
side effects were similar between groups [23]. The success
of postoperative pain control has an influence on a
patient’s satisfaction, however there may be possible factors
affecting the feeling of satisfaction. Thus one must be careful
when interpreting results about satisfaction, since factors
such as pain threshold, anxiety of the patient, interaction
of the patient, and the behavior of ward nurses may also be a
contributing factor.
There are several limitations in the present study. First, the
absence of a group treated with paracetamol after cord
clamped is an important limitation of this study. It may be pro-
vided a significant contribution in terms of the timing of drug
administration in pregnant women for postoperative pain re-
lief. Second limitation of our study is the lack of the assess-
ment of the surgeons' satisfaction levels. This could have let
us evaluate the compatibility of surgeons' and patients' satis-
faction scores. Another limitation is the lack of assessment of
hospital discharge times. We are of the opinion that this vari-
able needs to be investigated with relation to how the differ-
ences in 24-hour morphine consumption affect the group's
time to hospital discharge.
5. Conclusions
Our study demonstrated that preoperative administration of
a single IV dose of paracetamol provided effective pain control
and reduced morphine consumption in the postoperative peri-
od compared with placebo treatments. Physicians should keep
in mind that preoperative use of paracetamol is an efficient, re-
liable and valuable option for postoperative pain relief in preg-
nant women undergoing cesarean sections.
Conflicts of interest
The authors declare no conflicts of interest.
Acknowledgement
This study was supported by Baskent University Research
Fund (Project number: KA13-180).
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