Comparison of the effects of Remifentanil, Paracetamol (Apotel), and Dexmedetomidine on postoperative pain management following abdominal hysterectomy

Abstract Background and Objective:Postoperative pain remains a significant clinical challenge, potentially triggering cardiovascular, respiratory, and endocrine complications. Adjuvant analgesics, including dexmedetomidine and remifentanil, are frequently utilized to optimize postoperative pain management. This study aimed to compare the analgesic efficacy of these agents following elective abdominal hysterectomy.Materials and Methods: This double-blind, randomized clinical trial enrolled 195 women scheduled for abdominal hysterectomy at Sina Ashtiani Hospital (Arak, Iran). Using block randomization, participants were allocated into three treatment groups: intravenous Paracetamol (Apotel), Dexmedetomidine, and Remifentanil. Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at predefined intervals. In addition, the duration of analgesia, total analgesic use, and hemodynamic indicators were recorded throughout the first 24 hours after surgery. Statistical tests were performed using SPSS software.Results: The total dose of analgesics used in the dexmedetomidine group was considerably less than the paracetamol group (P=0.041), with significantly longer duration of analgesia (P<0.0001). VAS scores after surgery were considerably lower in the dexmedetomidine group than in the other two groups (P<0.0001). Moreover, the mean arterial pressure (MAP) and heart rate were considerably lower, and arterial oxygen saturation (SpO2) was higher in the dexmedetomidine group than in the others (P<0.05).Conclusion: Dexmedetomidine is better than remifentanil and paracetamol (Apotel) in patients undergoing abdominal hysterectomy. It decreases postoperative analgesic demand and prolongs the duration of analgesia and gives a better hemodynamic profile, hence better management of blood pressure, heart rate, and oxygen saturation. Trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20191104045328N45. Registered on 9 October 2025 (prospectively registered).