Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: results of a prospective, randomized, double-blind, multicenter clinical trial.
BACKGROUND
In recent years, intravenously (IV) administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen's analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This doubleblind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy.


METHODS
Eighty women aged 25-70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale) were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance.


RESULTS
Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05), and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039). The two groups had no significant differences in terms of adverse effects.


CONCLUSIONS
Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy.
Iran University of Medical Sciences, Tehran, Iran.
Hamid Reza
HR
Faiz
Iran University of Medical Sciences, Tehran, Iran.
Poupak
P
Rahimzadeh
VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA.
Ognjen
O
Visnjevac
Iran University of Medical Sciences, Tehran, Iran.
Behzad
B
Behzadi
Iran University of Medical Sciences, Tehran, Iran.
Mohammad Reza
MR
Ghodraty
VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA.
Nader D
ND
Nader
abdominal hysterectomy; analgesia; intravenous acetaminophen; ketamine; postoperative pain