Comparison of the Post-Operative Rescue Analgesia Administration between Analgesics Alone Regimen and Analgesics-Adjuvant Ascorbic Acid Regimen in Abakaliki, South East Nigeria

Abstract

Background: Management of pain postoperatively is a dilemma to the surgeons and anaesthetists. Intravenous ascorbic acid with its antinociceptive and neuromodulatory properties has been found to be an effective adjuvant to multimodal analgesia regimen in reducing the demand for rescue analgesia. Objective: To compare the post-operative rescue analgesia administration between analgesics alone regimen and analgesics-adjuvant ascorbic acid regimen in Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Study Design: A randomized double blind controlled comparative study involving parturient who received intravenous ascorbic acid as an adjuvant to suppository diclofenac and intravenous paracetamol for post-operative pain management after caesarean section and those who received intravenous sterile water (placebo), suppository diclofenac and intravenous paracetamol for post-operative pain management after caesarean section. Methodology: A total of 164 parturient who satisfied the inclusion criteria were recruited for the study by systematic sampling method. These were equal number of 82 participants in each group. Group A received intravenous ascorbic acid as an adjuvant to suppository diclofenac and intravenous paracetamol for post-operative pain management while Group B received intravenous sterile water (placebo), suppository diclofenac and intravenous paracetamol. The results were analyzed using SPSS version 26 with appropriate tables and figures generated. Results: The mean pain score at 2 hours after surgery was significantly higher in Group B when compared with Group A (6.9 ±1.4 vs.3.2 ±1.5; P<0.0001). At first request for analgesia, the mean numerical rating scale (NRS) was significantly higher in Group B compared to Group A (6.9 ±0.9 vs.6.1 ±0.7; P<0.0001). Time to first request for analgesia was longer for parturient in Group A (180.6 ± 65.6 mins) than those in group B (92.4± 35.4 mins; P<0.0001). Group B participants 48 (58.5%) requested for rescue analgesia twice against 25 (30.5%) in Group A(P=0.007). Conclusion: Demand for post-operative rescue analgesia due to moderate and severe pain was higher in participants who received analgesics alone regimen as opposed to their analgesics-adjuvant ascorbic acid regimen counterparts. Recommendation: Multi-center clinical trials are needed to strengthen the evidence provided by this study.