Saloni Bansal
B.P.S. Government Medical College for Women , India
Title: Pain relief following day care laparoscopic tubal ligation in conscious sedation with intravenous paracetamol: a randomised prospective study
Biography
Biography: Saloni Bansal
Abstract
Laparoscopic tubal ligation is one of the most commonly performed sterilization procedures offering advantages like a high success rate and early return to normal activity, but the appropriate anaesthetic technique has not been defined. Pain in laparoscopic tubal ligation is mediated through the release of prostaglandins from the traumatized tubes which causes uterine contraction and crampy lower abdominal pain. To provide adequate anaesthesia and relaxation with minimal side-effects, drug has to be short acting, but with appropriate duration of action. There are various scales available for pain assessment, most reliable being visual analogue scale. Another behavioural rating scale for those unable to provide a self-report of pain. It is based on clinical observation and scored from 0–10.
Apart from minor side-effects like nausea, vomiting and dizziness the reported case-fatality rate for tubal sterilization is 3.6/100,000 procedures with general anaesthesia. Local anesthesia with sedation, has also been suggested as another anaesthetic technique but its effectiveness has still been a questionmark. May be the quality of anesthesia is unsatisfactory due to discomfort and contraction of abdominal muscles, but it offers the advantage of patient being awake, oriented, breathing spontaneously and fast-tracks recovery which is the main aim of day care laparoscopic tubal ligation. Hence the choice of anaesthesia should be individualized, based on anesthetic and/or obstetric risk factors and patient preference.
Present study aims to evaluate the role of intravenous paracetamol, as an effective analgesic. Paracetamol is a reliable option with a pharmacokinetic profile which is linear up to 2 g after single administration.The maximal plasma concentration (Cmax) of paracetamol is observed at the end of 15-minutes of intravenous infusion which is 30μg/mL. Plasma half-life being 2.7 hours. Since paracetamol’s side effect profile is considerably superior, it is preferable over usual analgesics like opiates and non-steroidal anti-inflammatory drugs.