Keywords : Pain management
A comparative study to evaluate the analgesic effect and some vital signs effects of intravenous (Remifentanil - Morphine – Paracetamol)
karbala journal of pharmaceutical sciences,
Volume 8, Issue 13, Pages 267-277
Background: Pain is problematic in intensive care units (ICU) patients because produces adverse psychological and physiological response that includes increased heart rate, blood pressure, respiratory rate, neuroendocrine secretion and psychological distress. Opioid medications play role in pain control, but may cause a harmful effects on some vital signs. The primary goal of acute pain management are pain control and attenuation of the negative physiological and psychological consequences of unrelieved pain.
Objectives: To compares effect of Paracetamol, morphine & remifentanil and their activity as analgesic on some vital sings.
Patients & Methods: A prospective study was carried out in intensive care unit in AL Hussein medical city in Karbala during the period from first of November 2016 to the 28Th of February 2017. 30 patients of both sex were involved in this study, aged from 18 to 65 years old. Eligible patients were randomly selected & classified to three groups A, B & C (10 patients each). Group A received Morphine intravenous bolus doses (1 mg/30 min), group B received Remifentanil infusion dose (0.1 mcg/ kg/ min), and group C received Paracetamol infusion dose (1g /6 hourly). Data including pain score, pulse rate & blood pressure, were recorded pre-treatment & then same data were taken & reported at 2 hours interval for 12 hours. The data were statistically analyzed by using T-test.
Results: It was found that Paracetamol has no significant effect on systolic, diastolic blood pressure and pulse rate (136 ± 4.65, 75 ± 2.96 , 94 ±4.39 ) respectively as it's mean ±standard deviation values compared with pre-treatment values that represent control (138 ± 3.73, 80 ± 2.96, 99 ± 3.41), but with morphine group (124 ± 3.02, 67 ± 3.20, 89 ±5.87) & remifentanil group (111 ±5.64, 61 ± 1.33, 82 ±5.27) respectively, in which they have shown significant effect on these vital signs (systolic, diastolic blood pressure and pulse rate) compared with their pre-treatment values (138 ± 3.73, 80 ± 2.96, 99 ± 3.41). In addition, it was found that Paracetamol has less significant effect on pain score (face, legs, activity, cry, consolability) FLACC scale (4 ± 0.31) at (2,4,6,10,12) hours intervals compared with its pre-treatment value (5 ± 0.18) which means that paracetamol has lower analgesia than the two other drugs, morphine(2 ± 0.32) and remifentanil(2 ± 0.26) respectively,
that have significant effect on FLACC scale at (2,4,6,8,10,12) hours intervals, compared with their pre-treatment values.
Conclusion:. Paracetamol as analgesic has more vital signs stability compared with morphine & remifentanil but it has less analgesic effects compared with the other two drugs.