Paracetamol Reduces Postoperative Pain and Rescue Analgesic Demand After Robot-Assisted Endoscopic Thyroidectomy by the Transaxillary Approach

Postoperative pain following endoscopic thyroidectomy, although less severe than after open methods, is still a source of marked discomfort and surgical stress. This clinical trial was conducted to determine if repeated intravenous paracetamol could decrease postoperative pain and rescue analgesic requirements after robot-assisted endoscopic thyroidectomy via the transaxillary approach. This prospective, randomized, double-blinded, and placebo-controlled study enrolled 124 women 21-60 years of age who were scheduled for elective gasless robot-assisted endoscopic thyroidectomy via the transaxillary approach. The patients were given placebo or 1 g of paracetamol as a 100 ml solution infused over 15 min 1 h before the induction of anesthesia, and then at 6-h intervals for the following 24 h. Postoperative pain scores were significantly lower at 1, 3, 6, and 24 h after surgery in the paracetamol group than in the placebo group. Significantly fewer patients in the paracetamol group received rescue analgesics compared to the placebo group (9.5% vs. 65.6%, respectively). First analgesic time was similar in the two groups. Postoperative nausea (44.3% vs. 22.2%) and vomiting (21.3% vs. 6.3%) were more frequent in the placebo group than in the paracetamol group. Other postoperative side effects, including sedation, confusion, and pruritus, were similar in the two groups. We concluded that repeated administration of 1 g of intravenous paracetamol over 24 h is easy, effective, safe, and well tolerated for pain management in patients with moderate to severe postoperative pain after gasless robot-assisted endoscopic thyroidectomy performed via the transaxillary approach.