Author(s):
Akhil Arun, Triveni L, Subhiksha V, Beulah Milton, Gomathy E
Email(s):
akhilarun1997@gmail.com
DOI:
10.52711/0974-360X.2025.00149 
Address:
Akhil Arun1*, Triveni L1, Subhiksha V1, Beulah Milton2, Gomathy E3
1Lecturer, Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Ponnekara P.O, Kochi, India - 682041.
1Department of Pharmacy Practice, Krupanidhi College of Pharmacy,12/1, Chikka Bellandur, Carmelaram Gunjur Road Varthur Hobli, Off Sarjapur Rd, Bengaluru, Karnataka 560035
2Professor and HOD, Department of Pharmacy Practice, Kruapnidhi College of Pharmacy,12/1, Chikka Bellandur, Carmelaram Gunjur Road Varthur Hobli, Off Sarjapur Rd, Bengaluru, Karnataka 560035.
3Professor and HOD, Department of OBG, MVJ Medical College and Research Hospital NH75, 30th Mile, Dandupalya Village Kolathur, Post, Hoskote, Karnataka 562114.
*Corresponding Author
Published In:
Volume - 18,
Issue - 3,
Year - 2025
ABSTRACT:
After a hysterectomy, efficient pain management is crucial to the healing and comfort of the patient. In order to manage post-hysterectomy pain, this study compared the effectiveness, safety, and cost-effectiveness of intramuscular (IM) diclofenac with intravenous (IV) acetaminophen. One hundred female patients who met the eligibility requirements for a hysterectomy were prospectively enrolled. Information about the patient's demographics, medical history, hysterectomy type, and current symptoms were noted. For pain relief, patients were randomized to receive IV acetaminophen or IM diclofenac. A standardized scale was used to measure pain at different points after therapy. Cost-effectiveness and adverse medication reactions were assessed as well. When compared to baseline, IV acetaminophen and IM diclofenac both significantly decreased pain scores at all observed time points (p < 0.05). Over the course of 24 hours, IV acetaminophen showed a more persistent analgesic effect. Disparities between the treatments were found by analysing adverse medication reactions; IV acetaminophen was linked to a lower incidence of injection site discomfort and vomiting. IV acetaminophen was regularly found to be more cost-effective than IM diclofenac, according to cost-effectiveness study. Compared to intramuscular diclofenac, IV acetaminophen is the more cost-efficient, safe, and effective analgesic alternative for treating pain following a hysterectomy. These results highlight the value of customized pain management techniques in clinical settings, with ramifications for improving patient outcomes and recuperation.
Cite this article:
Akhil Arun, Triveni L, Subhiksha V, Beulah Milton, Gomathy E. A Comparative Cost-Effectiveness Analysis of Intravenous Infusion Acetaminophen and Intramuscular Diclofenac for Post-Hysterectomy Pain Management: The AIDA Study. Research Journal Pharmacy and Technology. 2025;18(3):1040-6. doi: 10.52711/0974-360X.2025.00149
Cite(Electronic):
Akhil Arun, Triveni L, Subhiksha V, Beulah Milton, Gomathy E. A Comparative Cost-Effectiveness Analysis of Intravenous Infusion Acetaminophen and Intramuscular Diclofenac for Post-Hysterectomy Pain Management: The AIDA Study. Research Journal Pharmacy and Technology. 2025;18(3):1040-6. doi: 10.52711/0974-360X.2025.00149 Available on: https://rjptonline.org/AbstractView.aspx?PID=2025-18-3-10
REFERENCES:
1. Hysterectomy - Why it’s necessary. nhs.uk. Published October 3, 2018. Accessed January 15, 2024. https://www.nhs.uk/conditions/hysterectomy/why-its-done/
2. Medscape Registration. Accessed February 15, 2024. https://emedicine.medscape.com/article/267273-overview?form=fpf
3. Hysterectomies in India: Prevalence, problems, and policies. orfonline.org. Accessed January 15, 2024. https://www.orfonline.org/expert-speak/hysterectomies-in-india
4. R K, Brundha MP. Prevalence of Hysterectomy in South Indian Population. Res J Pharm Technol. 2016; 9(11): 1941-1944. doi:10.5958/0974-360X.2016.00398.X
5. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10: 2287-2298. doi:10.2147/JPR.S144066
6. Ramamoorthy L. Post-operative Pain Management Strategies: Nursing Perspectives. Asian J NursEduc Res. 2021; 11(2): 189-192. doi:10.5958/2349-2996.2021.00046.X
7. Perioperative Pathways: Enhanced Recovery After Surgery. Accessed January 15, 2024. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/09/perioperative-pathways-enhanced-recovery-after-surgery
8. Rallabhandi S, Chakole V, Singam A. Comparison of Transdermal Fentanyl Patch and Intravenous Fentanyl for Postoperative pain relief in patients undergoing major abdominal surgeries under general Anaesthesia. Res J Pharm Technol. Published online 2021; April, 29: 1915-1918. doi:10.52711/0974-360X.2021.00338
9. Bohringer C, Astorga C, Liu H. The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It. TranslPerioper Pain Med. 2020; 7(1): 152-157.
10. Verma V, Yogi B, Gupta SK. Synthesis of Novel N- (substituted phenyl)-N- (substituted) acetamide Derivatives as a potent Analgesic agent. Res J Pharm Technol. 2020; 13(11): 5158-5164. doi:10.5958/0974-360X.2020.00902.6
11. Salunke N, Kumar MK, Yogesh, et al. Randomized Placebo Controlled Open Labelled Comparison of Efficacy of Diclofenac Transdermal Patch in Post Operative Pain. Res J Pharm Technol. 2019; 12(3): 1119-1121. doi:10.5958/0974-360X.2019.00184.7
12. D GB, Raiyani PD. Postoperative pain after spine surgery: Comparative efficacy of diclofenac and etoricoxib in combination with tramadol and paracetamol at lower doses. Res J PharmacolPharmacodyn. 2013; 5(1): 62-69.
13. Kholili U, HaryoNugroho Y, Sugihartono T, A. Nusi I, BoediSetiawan P. Liver injury associated with Acetaminophen: A Review. Res J Pharm Technol. Published online 2023; April, 29: 2006-2012. doi:10.52711/0974-360X.2023.00329
14. Gerriets V, Anderson J, Nappe TM. Acetaminophen. In: StatPearls. StatPearls Publishing; 2023. Accessed January 15, 2024. http://www.ncbi.nlm.nih.gov/books/NBK482369/
15. Ohashi N, Kohno T. Analgesic Effect of Acetaminophen: A Review of Known and Novel Mechanisms of Action. Front Pharmacol. 2020; 11: 580289. doi:10.3389/fphar.2020.580289
16. Alfaro RA, Davis DD. Diclofenac. In: StatPearls. StatPearls Publishing; 2023. Accessed January 15, 2024. http://www.ncbi.nlm.nih.gov/books/NBK557879/
17. Pal A, Biswas J, Mukhopadhyay P, Sanyal P, Dasgupta S, Das S. Diclofenac is more effective for post-operative analgesia in patients undergoing lower abdominal gynecological surgeries: A comparative study. Anesth Essays Res. 2014; 8(2): 192. doi:10.4103/0259-1162.134502
18. Visual Analogue Scale | Yale Assessment Module Training. Accessed February 15, 2024. https://assessment-module.yale.edu/im-palliative/visual-analogue-scale
19. Abubakar AR, Simbak NB, Haque M. Adverse Drug Reactions: Predisposing Factors, Modern Classifications and Causality Assessment. Res J Pharm Technol. 2014; 7(9): 1091-1098.
20. Labianca R, Sarzi-Puttini P, Zuccaro SM, Cherubino P, Vellucci R, Fornasari D. Adverse Effects Associated with Non-opioid and Opioid Treatment in Patients with Chronic Pain. Clin Drug Investig. 2012; 32(1): 53-63. doi:10.2165/11630080-000000000-00000
21. Martinez L, Ekman E, Nakhla N. Perioperative Opioid-sparing Strategies: Utility of Conventional NSAIDs in Adults. ClinTher. 2019; 41(12): 2612-2628. doi:10.1016/j.clinthera.2019.10.002
22. Nwosu I, Bougie O, Pudwell J. Evaluation of Opioid Prescribing Patterns and Use Following Hysterectomy for Benign Indication: A Prospective Cohort Study. J ObstetGynaecol Can JOGC J ObstetGynecol Can JOGC. 2022; 44(3): 240-246.e1. doi:10.1016/j.jogc.2021.09.019
23. Sorrentino F, Petito A, Angioni S, et al. Impact of anxiety levels on the perception of pain in patients undergoing office hysteroscopy. Arch Gynecol Obstet. 2021; 303(4): 999-1007. doi:10.1007/s00404-020-05885-9
24. Scheel J, Sittl R, Griessinger N, et al. Psychological Predictors of Acute Postoperative Pain After Hysterectomy for Benign Causes. Clin J Pain. 2017; 33(7): 595. doi:10.1097/AJP.0000000000000442
25. Bairy LK, Satyam SM, Shetty P. An insight on pain modulation with gender and obesity: A systematic review. Res J Pharm Technol. 2020; 13(12): 6284-6290. doi:10.5958/0974-360X.2020.01093.8
26. Indra V. Effective Pain Management to Improve Patient satisfaction – A Review. Int J NursEduc Res. 2019; 7(4): 613-615. doi:10.5958/2454-2660.2019.00138.8
27. Ismail S, Siddiqui AS, Rehman A. Postoperative pain management practices and their effectiveness after major gynecological surgery: An observational study in a tertiary care hospital. J AnaesthesiolClinPharmacol. 2018; 34(4): 478. doi:10.4103/joacp.JOACP_387_17
28. 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 Pain Res. 2014; 7: 65-70. doi:10.2147/JPR.S53234
29. Urman RD, Boing EA, Pham AT, et al. Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies. J Clin Med Res. 2018; 10(6): 499-507. doi:10.14740/jocmr.v10i6.3380
30. Shah UD, Dudhwala KN, Vakil MS. Prospective, double-blind randomized study of comparison of analgesic efficacy of parenteral paracetamol and diclofenac for postoperative pain relief. J AnaesthesiolClinPharmacol. 2019; 35(2): 188-191. doi:10.4103/joacp.JOACP_384_16
31. Mulita F, Karpetas G, Liolis E, Vailas M, Tchabashvili L, Maroulis I. Comparison of analgesic efficacy of acetaminophen monotherapy versus acetaminophen combinations with either pethidine or parecoxib in patients undergoing laparoscopic cholecystectomy: a randomized prospective study. Med Glas Off Publ Med AssocZenica-DobojCant Bosnia Herzeg. 2021; 18(1): 27-32. doi:10.17392/1245-21
32. Swathi NL, Basavan I, Muzzamil M, Venkatesan A, Rama GS, Arun A. Precision Medicine and Epigenetics: Personalized Diabetes Care. In: Prabhakar PK, ed. Advances in Bioinformatics and Biomedical Engineering. IGI Global; 2024: 288-309. doi:10.4018/979-8-3693-1922-2.ch014