Evidence for the Efficacy of an Opioid-Sparing Effect of Intravenous Acetaminophen in the Surgery Patient: A Systematic Review (original) (raw)
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The impact of intravenous acetaminophen on pain after abdominal surgery: a meta-analysis
The Journal of surgical research, 2018
Pain after surgery is commonly controlled with opioid pain medications. A multi-modal pain strategy that involves acetaminophen may help minimize the negative consequences of opioids, such as ileus, respiratory depression, and addictive potential. There are limited data on the effectiveness of intravenous (IV) acetaminophen in comparison with other nonopioid pain medications. Four databases were queried for the keywords "acetaminophen," "intravenous," and "postoperative". Prospective studies of adult patients receiving at least 24 h of IV acetaminophen after intraabdominal surgery were analyzed for 12- and 24-h pain scores and 24-h narcotic consumption. A random effects model was performed using mean differences and 95% confidence intervals to assess the effect of IV acetaminophen on outcomes. Heterogeneity was assessed using χ and the I statistics. Seventeen articles were identified that complied with inclusion and exclusion criteria. There was no sign...
British Journal of Anaesthesia, 2005
Background. Acetaminophen is commonly used for the management of perioperative pain. However, there is a marked discrepancy between the extent to which acetaminophen is used and the available evidence for an analgesic effect after major surgery. The aim of this systematic review is to determine the morphine-sparing effect of acetaminophen combined with patient-controlled analgesia (PCA) with morphine and to evaluate its effects on opioid-related adverse effects. Methods. MEDLINE and the Cochrane Library were searched to select randomized controlled trials which compared PCA morphine alone with PCA morphine plus acetaminophen administered orally or intravenously. Studies were evaluated for their quality based on the Oxford Quality Scale. Outcome measures were morphine consumption over the first 24 h after surgery, patient satisfaction and the incidence of morphine side-effects, including nausea and vomiting, sedation, urinary retention, pruritus and/or respiratory depression. Results. Seven prospective randomized controlled trials, including 265 patients in the group with PCA morphine plus acetaminophen and 226 patients in the group with PCA morphine alone, were selected. Acetaminophen administration was not associated with a decrease in the incidence of morphine-related adverse effects or an increase in patient satisfaction. Adding acetaminophen to PCA was associated with a morphine-sparing effect of 20% (mean, À9 mg; CI À15 to À3 mg; P=0.003) over the first postoperative 24 h. Conclusion. Acetaminophen combined with PCA morphine induced a significant morphinesparing effect but did not change the incidence of morphine-related adverse effects in the postoperative period.
Hospital Pharmacy, 2016
BackgroundPostoperative pain is managed with opioids, which are associated with adverse effects. The efficacy of intravenous (IV) acetaminophen in reducing opioid consumption has been studied with inconsistent results. The primary outcome of this study was to assess the effect of IV acetaminophen on opioid consumption 24 hours postoperatively. Secondary outcomes included the opiate consumption at 48 hours after the operation, opioid-related side effects 72 hours after the operation, discharge disposition, and length of stay.MethodsThis was an IRB-approved, retrospective cohort study including adult patients who underwent an elective total knee arthroplasty (TKA). Patients were stratified into IV and no IV acetaminophen groups; patients who had received at least one dose of IV acetaminophen were included in the IV acetaminophen group. Total opioids were collected, converted to morphine equivalents, and compared between groups. Patients were excluded for alcohol abuse, substance abuse...
2019
Introduction: Post operative pain after surgery is a cause of significant morbidity and patient dissatisfaction. In this study we try to compare efficacy between 1 gram acetaminophen oral dose with 1 gram acetaminophen intravenous dose in controlling post operative pain. Material and methods: This study is a prospective, randomized and comparative study conducted at NRI institute of medical sciences, Visakhapatnam between Oct 2016 to October 2017. 90 patients belonging to ASA status I and II of both genders, age group-18 to 60 years and undergoing surgeries under general anaesthesia lasting less than 2 hours were enrolled for the study. 2 groups out of which Group A received 1gm oral paracetamol and Group B received 1gm intravenous paracetamol. The grous were compared post operatively for pain scores at 30, 60, 90, 120, 150 minute after surgery using visual analogua scale(VAS) results: The mean VAS scores were 2.78, 4.07, 5.81, 6.36, 6.5 for Group A and 2.18, 3.5, 4.76, 6.04, 6.43 for Group B. Thus pain scores were consistently lesser in Group B than Group A. Pain scores were significantly lower in Group B during the time period 30 mins and 90 mins (p values 0.039 and 0.002 respectively). The time of first rescue analgesia (i.e, Fentanyl) was compared in both the groups. Mean for time of demand for analgesia was 88.67 mins and 102 mins in Group A and Group B respectively. P value was 0.05 thus a significantly earlier requirement of rescue analgesia in Group A. Conclusion: The rescue analgesic requirement was significantly lesser in intravenous acetaminophen group. Hence 1gm intravenous paracetamol is superior to oral formulation in controlling post operative pain.
Pain practice : the official journal of World Institute of Pain, 2012
Good surgical outcomes depend in part on good pain relief, allowing for early mobilization, optimal recovery, and patient satisfaction. Postsurgical pain has multiple mechanisms, and multimechanistic approaches to postoperative analgesia are recommended and may be associated with improved pain relief, lowered opioid doses, and sometimes a lower rate of opioid-associated side effects. Acetaminophen (paracetamol) is a familiar agent for treating many types of pain, including postsurgical pain. Oral acetaminophen has been shown to be safe and effective in a variety of acute pain models. Combination products using a fixed-dose of acetaminophen and an opioid have also been effective in treating postsurgical pain. Combination products with acetaminophen have demonstrated an opioid-sparing effect, which inconsistently results in a reduced rate of opioid-associated side effects. Intravenous (IV) acetaminophen and an opioid analgesic administered in the perioperative period may be followed b...
Effect of Intravenous Acetaminophen on Postoperative Opioid Use in Bariatric Surgery Patients
PubMed, 2015
Background: The use of opioids to achieve adequate pain relief following surgery is a common clinical practice. Opioids, however, are associated with serious adverse effects, such as respiratory depression, excessive sedation, and prolonged ileus, as well as increased mortality. The administration of intravenous (IV) acetaminophen to control postoperative pain has been effective in reducing opioid consumption in various surgical populations, but no studies have been conducted in bariatric surgery patients. This investigation was performed to determine whether IV acetaminophen reduces opioid requirements after bariatric surgery. Methods: IV acetaminophen was added to the Winthrop-University Hospital formulary in September 2012. We conducted a retrospective chart-review analysis of bariatric surgery patients who received at least four doses of IV acetaminophen (1 g every six hours) plus opioids from October 2012 to March 2013 (after IV acetaminophen was added to the hospital formulary), compared with bariatric surgery patients who received only opioids for postoperative pain control from January 2012 to June 2012 (before IV acetaminophen was added to the hospital formulary). The study's primary endpoint was the difference between the two groups in opioid consumption, expressed in oral morphine equivalents (OMEs). Secondary endpoints included the reduction in the baseline pain score; the total amount of each opioid used; and the average hospital length of stay (LOS). Results: A total of 96 patients were identified for potential enrollment from January 2012 to March 2013. Eight patients, however, did not qualify for participation because they had received only one dose of IV acetaminophen. The remaining 88 patients comprised two study groups: IV acetaminophen plus opiates (n = 44) and IV opiates alone (n = 44). Paradoxically, the patients in the acetaminophen/opiates group required significantly more opiates (in OMEs) compared with the group that received opiates alone (median, 93.5 mg versus 63.0 mg, respectively; P = 0.017). There were no significant differences between the two treatment groups in terms of the median change from baseline in pain scores (-4 versus -4; P = 0.162) or the median hospital LOS (two days versus two days; P = 0.704). Conclusion: IV acetaminophen did not reduce opioid use for postoperative pain management in bariatric surgery patients.
Postoperative opioid analgesia: Time for a reconsideration?
Journal of Clinical Anesthesia, 1996
Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehkt H: Postoperative pain relief-wh,at is the issue? Br J Anaesth 1994;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (N) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly better analgesic effects, and also fewer unwanted side effects.
Pain medicine (Malden, Mass.), 2016
OBJECTIVE : The management of postoperative pain is a major health care issue. While the cost of intravenous acetaminophen (IVA) is significantly greater than its oral acetaminophen (OA) counterpart, less is known regarding comparative effectiveness of these routes. The purpose of this study was to determine whether perioperative IVA is equivalent in reducing postoperative pain compared with perioperative OA for laparoscopic cholecystectomy (LapChole). Double-blinded, prospective, randomized placebo-controlled trial. Womack Army Medical Center, Fort Bragg, North Carolina. Adults (age > 18 years) active duty military, veterans, and beneficiaries receiving a laparoscopic cholecystectomy. This study was conducted at Womack Army Medical Center (WAMC), Fort Bragg, North Carolina, between January 2013 and June 2015. Sixty-seven subjects with symptomatic cholelithiasis were randomly assigned to receive two doses (1,000 mg each) of either IVA or OA. A numerical rating scale (NRS) sco...
Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2021
PURPOSE Postoperative pain is typically treated with multimodal analgesia, using systemic acetaminophen and/or nonsteroidal anti-inflammatory drugs in conjunction with opioids as required. The present study aimed to determine the safety and tolerability of repeated doses of an intravenous fixed-dose combination (FDC) of acetaminophen and ibuprofen. METHODS This multicenter, open-label, single arm, multiple dose study was conducted at 4 centers across New Zealand and the United States between July 2019 and July 2020. Adults (>18 years) requiring multiple doses of parenteral nonopioid analgesics over multiple days following non-laparoscopic general, plastic or orthopedic surgery were eligible. The study drug (acetaminophen 1000 mg+ibuprofen 300 mg) was administered 6-hourly as a 5 min infusion for between 48 h and 5 days. Adverse event data was collected throughout the study, in addition to scheduled vital sign assessments, laboratory tests and electrocardiograms. Participants comp...