Intravenous paracetamol for cesarean caesarean analgesia-elixir or lolly water?

Intravenous paracetamol bottles have appeared on the shelves of the obstetric theatre operating room like stubbies in the cricket club change shed. Are they just another expense to the economy and another stress on the environment, or does IV paracetamol actually do some good? A pubmed search finds little that recommends the use of paracetamol by any route for caesarean. For other surgery, a metaanalysis in Anesthesiology Dec 2005 by Elia et al concludes that only NSAIDs are analgesic. At most, paracetamol is opioid sparing, but it offers little more over an NSAID that has already been given. But until recently it has been a very cheap drug, with few side-effects. (The potential for liver necrosis is always possible though, and there have been iatrogenic perioperative cases.) So it has been commonly given in recent times: a cheap, harmless and probably useless effort which at least comes with good intentions. But now it comes in a big jar, which needs venting. In dental surgery IV proparaectamol's onset of action is very rapid, but ultimately is less effective than the oral route 2-3 hours later (Moller, BJA 94 5) because it presumably redistributes. So why give IV paracetamol to a patient who is blocked with regional anaesthesia, and will be for another hour or two? Its peak effect (which is little anyway) will have peaked and waned by the time the regional anaesthesia has resolved. So if paracetamol must be given why not give it in its oral form? Oral medication is usually well absorbed and tolerated after caesarean section. Oral paracetamol is cheap and palatable, and its onset time will more likely correspond to the time of anaesthesia's end . But for all the good it does, you may as well stick it up an arse.