Comparison of Pain Control and Inflammatory Profile in Cesarean Section Patients Treated with Multimodal Analgesia Utilizing Paracetamol and Ibuprofen

Syafruddin Gaus; Yudhitya		 Afif; Alamsyah Ambo Ala; Andi Husni	 Tanra; Ratnawati Ratnawati; Muhammad Rum

doi:10.3889/oamjms.2023.10853

Authors

Syafruddin Gaus Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Yudhitya Afif Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Alamsyah Ambo Ala Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Andi Husni Tanra Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Ratnawati Ratnawati Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Muhammad Rum Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.10853

Keywords:

paracetamol, ibuprofen, Cesarean Section, spinal anesthesia

Abstract

AIM: This single-blind study aimed to compare the combination of paracetamol with various doses of ibuprofen as multimodal analgesia in C-section surgery patients under spinal anesthesia. Levels of interleukin (IL)-6 and C-reactive protein (CRP) were analyzed as markers of inflammation.

METHODS: Treatment groups (20 patients each) were: Group A, 750 mg paracetamol and 400 mg ibuprofen; Group B, 750 mg paracetamol and 600 mg ibuprofen; and Group C, 750 mg paracetamol and 800 mg ibuprofen. Degree of pain (movement and rest), scored using the numeric rating scale (NRS) and levels of IL-6 and CRP were assessed at various time points within 24 h of surgery. Side effects and numbers of subjects requiring rescue fentanyl administration were also recorded.

RESULTS: Group C showed a rest NRS score of 1.00 ± 0.00 6 h postoperatively, compared with 2.00 ± 0.00 in Group B and 2.35 ± 0.87 in Group A. 4 h postoperatively, movement NRS scores were 1.00 ± 0.00 for Group C, compared to 3.00 ± 1.77 for Group B, and 4.85 ± 1.81 for Group A. At 12 h, IL-6 levels hours were 2.66 ± 0.04 pg/mL for Group A, 2.39 ± 0.02 pg/mL for Group B, and 2.05 ± 0.01 pg/mL for Group C. At 6 h, CRP levels were 1.18 ± 0.04 mg/L for Group A, 0.95 ± 0.01 mg/L for Group B, and 0.70 ± 0.02 mg/L for Group C. Overall, Group C showed the lowest values for all parameters analyzed, compared with other groups, and the differences were significant (p < 0.05). In addition, none of the patients in Group C required rescue fentanyl (p < 0.05), and no patients in any of the groups showed any side effects.

CONCLUSION: For pain management after C-section surgery, the combination of 750 mg paracetamol and 800 mg ibuprofen yielded the best results as assessed by NRS scores, levels of IL-6 and CRP, and fentanyl rescue.

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