Comparative Study of the Analgesic Profiles of a New Intravenous Paracetamol Preparation, Ketorolac, and Their Combination in Day Case Otorhinolaryngologic Surgeries

This study was done on 60 adult patients who had day case otorhinolarngologic surgeries. Patients were allocated into three groups, according to perioperative analgesic used: Group 1 (n =20) was given 30 mg ketorolac IV, Group 2 (n=20) was given a new solubilised paracetamol formulation (Perfalgan 10mg/ml) lgm IV infusion, and Group 3 (n=20) was given 30mg ketorolac IV plus Perfalgan lgm IV infusion. Analgesic profiles were evaluated using the sum of pain intensity difference after 6 and 12 hours of drug intake (SPID6 12), total pain relief score after 6 and 12 hours of drug intake (TOTPAR6 12), global patient satisfactionwith pain control, and use of rescue analgesics. Surgeons satisfaction with intraoperative bleeding and surgical field, in addition to bleeding time were also studied as indications of tolerability to the drugs. This study demonstrated no significant differences in pain scores between ketorolac and Perfalgan, while SPID6 12 and TOTPAR6 12 were significantly higher in the combination group (11.6±2.1 and 20.2±4.5, p=0.01 and 0.022 respectively for SPID6 12 and 19.6±6.2 and 39.3±8.6, p=0.001 and 0.003 respectively for TOTPAR6 12) indicating much less pain intensity and better pain relief with the combination. In addition, fewer patients in the combination group required rescue pethedine, while no significant difference was detected in the use of rescue pethidine between the other two groups. Fourteen patients in the combination group rated their satisfaction for the analgesic regimen as very good to excellent, while only one patient in the ketorolac group had a very good response, and none of the Perfalgan group had a very good to excellent response. Surgeons satisfaction with intraoperative surgical bleeding and surgical field was satisfactory to excellent in all groups. In addition, postoperative bleeding times in all groups did not show any significant prolongation 12 hours after discharge from recovery room. In Conclusion-. This study has demonstrated that the use of a combination of paracetamol IV infusion in the new formulation known as Perfalgan lg and IV ketorolac 30mg for control of postoperative pain in day case otorhinologic surgeries was efficient and enough to avoid the use of additional narcotics, and had a better analgesic efficacy than either drug alone, without any significant side effects on intraoperative or postoperative surgical bleeding.