title: The effect of intravenous preemptive paracetamol on postoperative fentanyl consumption in patients undergoing open nephrectomy: a prospective randomized study.
abstract: OBJECTIVE
  We investigated the efficacy of intravenous (IV) preemptive paracetamol on postoperative total fentanyl consumption and fentanyl-related side effects in patients undergoing open nephrectomy.
  
  
  METHODS
  A total of 60 patients scheduled for elective open nephrectomy under general anesthesia were included. All patients received Patient-controlled IV analgesia with fentanyl postoperatively. Patients were randomly allocated into three equal groups: The fentanyl group received 100 mL of IV normal saline as a placebo, with the first dose ending 30 min before intubation. In paracetamol group, IV 1 g paracetamol was given to the patients 30 min after extubation with repeated doses every 6 h totally 4 times a day. In preemptive paracetamol group, patients received IV 1 g paracetamol every 6 h, with the first dose ending 30 min before intubation.
  
  
  RESULTS
  Postoperative cumulative fentanyl consumption for 24 h was significantly higher in the fentanyl group (1009 ± 139.361 μg) than those of paracetamol (752.25 ± 112.665 μg) and preemptive paracetamol groups (761.10 ± 226.625 μg) (P = 0.001 for both). In early postoperative period (0-4 h); whereas total fentanyl consumption showed no statistically significant difference among groups (P = 0.186), the nausea-vomiting scores were significantly higher in the fentanyl group compared with other groups (P = 0.012).
  
  
  CONCLUSIONS
  In patients undergoing open nephrectomy, use of preemptive or postoperative paracetamol reduces fentanyl related nausea-vomiting without a decrease in total fentanyl consumption in the early postoperative period. Furthermore, use of preemptive or postoperative paracetamol reduces total fentanyl requirements in the first 24 h postoperatively providing a safe and effective postoperative analgesia.
authors.forename: S S
authors.initials: SS
authors.lastname: Unal
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Aksoy
authors.forename: A
authors.initials: A
authors.lastname: Ahiskalioglu
authors.forename: A F
authors.initials: AF
authors.lastname: Erdem
authors.forename: S
authors.initials: S
authors.lastname: Adanur
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000768:Anesthesia, General; D018890:Chemoprevention; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D005283:Fentanyl