title: Intravenous acetaminophen vs oral ibuprofen in combination with morphine PCIA after Cesarean delivery.
abstract: OBJECTIVE
  To compare the effects of iv acetaminophen with those of oral ibuprofen with respect to postoperative pain control and morphine requirements in patients receiving morphine patient-controlled iv analgesia (PCIA) after Cesarean delivery.
  
  
  METHODS
  Forty-five term patients scheduled for Cesarean delivery were randomized to receive acetaminophen 1 g iv every six hours plus oral placebo (group A) or ibuprofen 400 mg po every six hours plus iv placebo (group I); the first dose of study drug was given 30 min preoperatively. Postoperatively, all patients received PCIA for 48 hr using morphine bolus dose 2 mg iv, lockout interval ten minutes, and no basal infusion. Visual analogue scale (VAS; 0 to 10) at rest and morphine requirements were recorded every hour for four hours then every four hours for a total of 48 hr postoperatively. Patient satisfaction was recorded on a ten-point scale (from 1 to 10) 48 hr postoperatively.
  
  
  RESULTS
  Visual analogue scale scores decreased similarly in both groups over time, however, there were no differences between groups at any time during the study period (estimated marginal means: 1.4 +/- SEM 0.2 vs 1.9 +/- SEM 0.2 for groups A and I, respectively, P = 0.124). Cumulative doses of postoperative morphine were 98 +/- 37 vs 93 +/- 33 mg for groups A and I, respectively (P = 0.628). Patient satisfaction with analgesia was high in both groups (9 +/- 1 vs 9 +/- 1, P = 0.93).
  
  
  CONCLUSIONS
  Intravenous acetaminophen is a reasonable alternative to oral ibuprofen as an adjunct to morphine patient-controlled analgesia after Cesarean delivery.
authors.affiliation: Department of Anesthesia & Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah 21418, Saudi Arabia. jalhashemi@kau.edu.sa
authors.forename: Jamal A
authors.initials: JA
authors.lastname: Alhashemi
authors.forename: Qamar A
authors.initials: QA
authors.lastname: Alotaibi
authors.forename: Manal S
authors.initials: MS
authors.lastname: Mashaat
authors.forename: Tarek M
authors.initials: TM
authors.lastname: Kaid
authors.forename: Razaz H
authors.initials: RH
authors.lastname: Mujallid
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Kaki
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000284:Administration, Oral; D000328:Adult; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002585:Cesarean Section; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D007275:Injections, Intravenous; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine; D007052:Ibuprofen