Comparison of intravenous paracetamol vs. intramuscular diclofenac for postoperative pain control in abdominal hysterectomy


  • Poonam Bisht Department of Obstetrics and Gynecology, Government Medical College, Haldwani, Uttarakhand, India
  • Geeta Jain Department of Obstetrics and Gynecology, Government Medical College, Haldwani, Uttarakhand, India



Diclofenac, Pain, Paracetamol, Tramadol, Visual analogue score


Background: Abdominal hysterectomy is one of the most common gynaecological surgery conducted worldwide. It is commonly associated with post operative pain. The aim of this study was Comparison of intravenous Paracetamol versus intramuscular Diclofenac for postoperative pain control in abdominal hysterectomy. Objectives of this study were to compare the effectiveness of intravenous Paracetamol and intramuscular Diclofenac when used for post-operative pain control in abdominal hysterectomy patients and to compare the need for rescue analgesia in both the groups.

Methods: It’s a prospective observational and clinically randomized study conducted in Department of Obstetrics and Gynaecology, Government Medical College Haldwani and associated Dr. Shushila Tiwari Government Hospital, Haldwani consisting of 120 patients undergoing abdominal hysterectomy. 60 patients in group A received Paracetamol 1000 mg (100ml infusion) intravenous followed by subsequent doses of 1000 mg every 8 hourly for 48 hrs and another 60 patients in group B received injection Diclofenac 75 mg intramuscular every 8 hourly for 48hrs. Pain intensity of patients was noted 2 hourly for 6 hours after giving the first dose of the drug and then at every 8 hour for next 48 hours, using VAS scoring. Patient’s hemodynamics in form of respiratory rate, heart rate, mean arterial pressure (MAP), oxygen saturation (sPO2) were monitored as per pain monitoring protocol.

Results: Post-op mean VAS score at different point of time among the two treatment groups was lower for Paracetamol group as compared to Diclofenac group. The difference was found to be statistically significant at all point of time post op. Adverse effect like nausea, vomiting and dizziness was seen more among Diclofenac group as compared to Paracetamol group.

Conclusions: Intravenous Paracetamol use was found to be associated with better postoperative pain relief and reduced need for rescue analgesia consumption in the postoperative period.

Author Biography

Geeta Jain, Department of Obstetrics and Gynecology, Government Medical College, Haldwani, Uttarakhand, India

Proffessor & Head of Department Obstetrics & Gynaecology


Brummer THI, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Mäkinen J, et al. FINHYST 2006 - national prospective 1-year survey of 5 279 hysterectomies. Hum Reprod. 2009;24:2515.

Kovac S. Route of hysterectomy: An evidence-based approach. Clin Obstet Gyn. 2014;57:58-71.

Pogatzki Zahn EM, Zahn PK, Brennan TJ. Postoperative pain—clinical implications of basic research. Best Pract Research Clinical Anaesthesiol. 2007;21:3-13.

Ip HYV, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: A qualitative systematic review. Anesthesiol. 2009;111:657-77.

Sede SS, Tanha FD, Valadan M, Modaressi Z. Comparison between preoperative rectal diclofenac plus paracetamol and diclofenac alone for postoperativepain of hysterectomy. J Family Reproductive Health. 2014;8(3):91.

Faiz HR, Rahimzadeh P, Visnjevac O, Behzadi B, Ghodraty MR, Nader ND. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: Results of a prospective, randomized, double-blind, multicenter clinical trial. J P Res. 2014;7:65.

AroraTrivedi P, Mehta M. A study of efficacy of a single dose of a transdermal diclofenac patch and intramuscular diclofenac-as pre-emptive postoperative analgesia in patients undergoing abdominal hysterectomy. Int J Res Med. 2015;4(4):96-101.

Paul D, Jacob M, Kulkarni SN. Comparative evaluation of efficacy of intravenous paracetamol and intravenous diclofenac as post-operative analgesia in laparoscopic cholecystectomy. Int Jour of Biomed Res. 2015;6(7):482.

Thorat, D.P., Singla, D.A., &Senjalia, D.H. (2017). Comparison of the Efficacy of Intravenous Paracetamol and Diclofenac for Post-Operative Analgesia. SJAMS. 2017;5(9A):3539-46.

Aghamir SK, Mojtahedzadeh M, Alizadeh F, Alizadeh F, Khalili H, Najafi A, et al. Paracetamol Vs. Tramadol for post-operative pain management after urologic surgery. The Internet J of Pharmacology. 2005;4:2.

Rani K, Zutshi V, Patel M, Marwah S. Analgesic efficacy of intravenous paracetamol versus intravenous tramadol after caesarean section: a single blind randomized controlled study. Int J ReprodContraceptObstet Gynecol. 2016;4285-9.

Ali MA, Shamim F, Chughtai S. Comparison between intravenous Paracetamol and fentanyl for intraoperative and postoperative pain relief in dilatation and evacuation. Journal of Anaesthesiology Clinical Pharmacol. 2015;31:54-8.

Abinaya A, Latha K, Jayashree V. Comparative study between intravenous paracetamol and intramuscular tramadol as labour analgesia. Int J Current Med Pharma Res. 2017;3(10).

Ayan M, Taş U, Söğüt E, Arıcı S, Karaman S, Esen M, et al. Comparing efficiencies of Diclofenac sodium and Paracetamol in patients with primary dysmenorrhea pain by using Visual Analog Scale. Agri. 2013;25(2):78-82.

Agrawal SA, Nikhate SD, Thakur MM, Bal H. A study of comparison of efficacy and side effects of intravenous paracetamol and intravenous diclofenac as a postoperative analgesic. Int J Reprod Contracept Obstet Gynecol. 2019;8(9):3684.

Goel P. Pre emptive analgesia with iv Paracetamol and iv Diclofenac sodium in patients undergoing various surgical procedures: a comparative study Int J Biol Med Res. 2013;4(3):3294-300.

Elbohoty AE, Abd-Elrazek H, Abd-El-Gawad M. Intravenous infusion of Paracetamol versus intravenous Pethidine as an intrapartum analgesic in the first stage of labor. Int J Gynaecol Obstet. 2012;118:7-10.

Turkay C, Nurten I, Safiye C. Intravenous Paracetamol Improves the Quality of Postoperative Analgesia but Does not Decrease Narcotic Requirements. Journal of Neurosurgical Anesthesiol. 2008;20(3):169-73.

Moon YE, Lee YK, Lee J, Moon DE. The effects of preoperative intravenous acetaminophen in patients undergoing abdominal hysterectomy. Arch Gynecol Obstet. 2011;284(6):1455–60.

Cobby TF, Crighton IM, Kyriakides K, Hobbs GJ. Rectal paracetamol has a significant morphine-sparing effect after hysterectomy. Br J Anaesth. 1999;83(2):253-6.

Varrassi G, Marinangeli F, Agrò F. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg. 1999;88(3):611-6.

Munushenkar B, Fettes P, Moore C, Mcleod GA. A double-blind randomized controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. International Journal of Obstetric Anesthesia. 2008;17:9-14.

McDaid C, Maund E, Rice S, Wright K, Jenkins B, Woolacott N. Health Technology Assessment, Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: A systematic review 2010;14:17.






Original Research Articles