Postoperative pain therapy after laparoscopic cholecystectomy: paracetamol versus diclofenac

Objectives: Laparoscopic cholecystectomy is the first treatment choice for symptomatic gallstone disease. We compared the efficacy of intravenous (i.v.) paracetamol and intramuscular (i.m.) diclofenac Na+ after laparoscopic cholecystectomy. Methods: Following approval from the Local Ethics Committee and receipt of written informed consent, 40 ASA physical status I-II patients who underwent laparoscopic cholecystectomy were enrolled into the study. General anesthesia was standardized. The patients received 1 gi.v. paracetamol (Group I, n: 20) or 75 mg diclofenac Na+ i.m. (GroupII, n: 20) 15 minutes (min) before the end of the operation. Pain was assessed by numeric rating scale (NRS) after arrival in the postanesthesia care unit (PACU) (NRS 1) and at the 30th minute (NRS 2) and 1st hour (NRS 3) of the PACU stay. 10 mg i.v. pethidine HCL was administered to the patient with NRS >5. The following measures were recorded: intensity of pain by NRS at arrival and after 30 and 60 min, total consumption of pethidine HCL, and nausea and vomiting. Results: All assessments were performed by an anesthesiologist blinded to the study protocol. NRS 3 scores were significantly higher in Group I than Group II (p<0.05). Opioid consumption was not different between the groups. Two patients in each group had postoperative nausea and vomiting; no other adverse effects were noted. Conclusion: We recommend the use of i.v. paracetamol as an opioid adjuvant. Regarding its use as a unique drug for postoperative pain therapy, further comparative studies with higher doses of paracetamol are needed.