ROLE OF PERIOPERATIVE ANALGESIA WITH ACETAMINOPHEN IN REDUCING PAIN FOLLOWING ELECTROCONVULSIVE THERAPY

Abstract

Objective: To assess the efficacy of perioperative analgesia with acetaminophen in reducing the occurrence and severity of post-ECT pain. Study Design: Quasi experimental study. Study Place and Duration: Tertiary care mental health facility at Rawalpindi, Jun to Nov 2018. Methodology: Patients of all age groups and either gender for whom elective ECT was recommended during the study time period were included in the study. Acetaminophen (1g/100ml) and placebo (100ml) infusions were infused according to randomized sequence during ECT session. Study participants were assessed for presence and severity of pain i.e. headache and/or myalgia, two hours before and after ECT by using visual analog scale (VAS). Results: A sum of 146 study participants were randomized to either receive intervention (Group A) or placebo (Group B), both the groups comprised of 73 participants each. The frequency of post-ECT headache and myalgia in group A, who received acetaminophen infusion, was 8.2% and 2.7% respectively as compared to placebo group B where incidence of post-ECT headache and myalgia was reported to be 24.7% and 10.9% respectively (8.2% vs 24.7%, p 0.013 and 2.7% vs 10.9%, p 0.03 respectively). Uni-variate analysis showed that participants in group A were 72.6% less likely to develop post-ECT headache (OR 0.27, 95% CI 0.11-0.73, p 0.007), and 55% less likely to develop post-ECT myalgia (OR 0.45, 95% CI 0.21-0.80, p 0.01) than participants in group B. Conclusion: Acetaminophen has been found effective in reducing the incidence and severity of headache and myalgia following electroconvulsive therapy.

Keywords

• electroconvulsive therapy
• headache
• myalgia
• perioperative analgesia