Rectal paracetamol has a significant morphine-sparing effect after hysterectomy

We have evaluated the morphine-sparing effect of rectal paracetamol during the first 24 h after abdominal hysterectomy in a placebo-controlled, double -blind study. We studied 72 patients receiving patient-controlled analgesia (PCA) with i.v. morphine after a standardized anaesthetic, allocated rando mly to receive rectal paracetamol 1.3 g, diclofenac 50 mg or placebo, after wound closure and at 8 and 16 h. Suppositories were blinded by the hospita l pharmacy. Study violations excluded data from seven patients. Patient dat a, morphine doses during anaesthesia and recovery, and sedation and nausea scores were comparable. Mean morphine consumption during PCA was 35.0 (SD 2 0.4) mg, 32.7 (27.4) mg and 54.9 (28.3) mg in the paracetamol (n=24), diclo fenac (n=20) and placebo (n=21) groups, respectively (P<0.05). Morphine spa ring during PCA for paracetamol and diclofenac (36% vs 40% over 24 h) was s ignificant from 4 h. Global scores of average pain over 24 h were lower aft er diclofenac compared with paracetamol (P<0.01)and placebo (P=0.08). We co nclude that rectal paracetamol was an efficacious adjuvant analgesic after regular dosing.