Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain
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TLDR
This review found 39 new studies providing additional information on the efficacy and safety of IV formulations of paracetamol for the treatment of postoperative pain in both adults and children, and Randomized, double-blind, placebo- or active-controlled single dose clinical trials of IV paracetmol or IV propacetaml for acute postoperativePain in adults or children.Abstract:
Background
This is an updated version of the original Cochrane review published in Issue 10, 2011. Paracetamol (acetaminophen) is the most commonly prescribed analgesic for the treatment of acute pain. It may be administered orally, rectally, or intravenously. The efficacy and safety of intravenous (IV) formulations of paracetamol, IV paracetamol, and IV propacetamol (a prodrug that is metabolized to paracetamol), compared with placebo and other analgesics, is unclear.
Objectives
To assess the efficacy and safety of IV formulations of paracetamol for the treatment of postoperative pain in both adults and children.
Search methods
We ran the search for the previous review in May 2010. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE (May 2010 to 16 February 2016), EMBASE (May 2010 to 16 February 2016), LILACS (2010 to 2016), a clinical trials registry, and reference lists of reviews for randomized controlled trials (RCTs) in any language and we retrieved articles.
Selection criteria
Randomized, double-blind, placebo- or active-controlled single dose clinical trials of IV paracetamol or IV propacetamol for acute postoperative pain in adults or children.
Data collection and analysis
Two review authors independently extracted data, which included demographic variables, type of surgery, interventions, efficacy, and adverse events. We contacted study authors for additional information. We graded each included study for methodological quality by assessing risk of bias and employed the GRADE approach to assess the overall quality of the evidence.
Main results
We included 75 studies (36 from the original review and 39 from our updated review) enrolling a total of 7200 participants.
Among primary outcomes, 36% of participants receiving IV paracetamol/propacetamol experienced at least 50% pain relief over four hours compared with 16% of those receiving placebo (number needed to treat to benefit (NNT) = 5; 95% confidence interval (CI) 3.7 to 5.6, high quality evidence). The proportion of participants in IV paracetamol/propacetamol groups experiencing at least 50% pain relief diminished over six hours, as reflected in a higher NNT of 6 (4.6 to 7.1, moderate quality evidence). Mean pain intensity at four hours was similar when comparing IV paracetamol and placebo, but was seven points lower on a 0 to 100 visual analog scale (0 = no pain, 100 = worst pain imaginable, 95% CI -9 to -6, low quality evidence) in those receiving paracetamol at six hours.
For secondary outcomes, participants receiving IV paracetamol/propacetamol required 26% less opioid over four hours and 16% less over six hours (moderate quality evidence) than those receiving placebo. However, this did not translate to a clinically meaningful reduction in opioid-induced adverse events.
Meta-analysis of efficacy comparisons between IV paracetamol/propacetamol and active comparators (e.g., opioids or nonsteroidal anti-inflammatory drugs) were either not statistically significant, not clinically significant, or both.
Adverse events occurred at similar rates with IV paracetamol or IV propacetamol and placebo. However, pain on infusion occurred more frequently in those receiving IV propacetamol versus placebo (23% versus 1%). Meta-analysis did not demonstrate clinically meaningful differences between IV paracetamol/propacetamol and active comparators for any adverse event.
Authors' conclusions
Since the last version of this review, we have found 39 new studies providing additional information. Most included studies evaluated adults only. We reanalyzed the data but the results did not substantially alter any of our previously published conclusions. This review provides high quality evidence that a single dose of either IV paracetamol or IV propacetamol provides around four hours of effective analgesia for about 36% of patients with acute postoperative pain. Low to very low quality evidence demonstrates that both formulations are associated with few adverse events, although patients receiving IV propacetamol have a higher incidence of pain on infusion than both placebo and IV paracetamol.read more
Citations
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Journal ArticleDOI
Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial.
Kasper Højgaard Thybo,Daniel Hägi-Pedersen,Jørgen B. Dahl,Jørn Wetterslev,Mariam Nersesjan,Janus Christian Jakobsen,Niels Anker Pedersen,Søren Overgaard,Søren Overgaard,Henrik Morville Schrøder,Harald Schmidt,Jan Gottfrid Bjørck,Kamilla Skovmand,Rune Frederiksen,Morten Buus-Nielsen,Charlotte Voss Sørensen,Laura Smedegaard Kruuse,Peter Lindholm,Ole Mathiesen +18 more
TL;DR: A randomized, blinded, placebo-controlled, 4-group trial in 6 Danish hospitals with 90-day follow-up that included 556 patients undergoing total hip arthroplasty (THA) to investigate beneficial and harmful effects of 4 nonopioid analgesics regimens.
Journal ArticleDOI
New Advances in Acute Postoperative Pain Management.
TL;DR: In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.
Journal ArticleDOI
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naïve Patients.
Christopher L. Wu,Adam B. King,Timothy M. Geiger,Michael C. Grant,Michael P.W. Grocott,Ruchir Gupta,Jennifer M. Hah,Timothy E. Miller,Andrew D. Shaw,Tong J. Gan,Julie K. M. Thacker,Michael G. Mythen,Matthew D. McEvoy,Charles Argoff,David A. Edwards,Debra B. Gordon,Padma Gulur,Traci L. Hedrick,Stefan D. Holubar,Robert W. Hurley,Jennifer Jayaram,Michael L. Kent,Gary M. Oderda,Erin Sun +23 more
TL;DR: The questions answered included what are the potential strategies for preventing persistent postoperative opioid use, is opioid-free anesthesia and analgesia feasible and appropriate for routine operations, and Is opioid- free (intraoperative) anesthesia associated with equivalent or superior outcomes compared to an opioid minimization in the perioperative period.
Journal ArticleDOI
The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse
Ellen M. Soffin,Ellen M. Soffin,Bradley H. Lee,Bradley H. Lee,Kanupriya Kumar,Kanupriya Kumar,Christopher L. Wu,Christopher L. Wu,Christopher L. Wu +8 more
TL;DR: A global strategy for decreasing perioperative opioid use and misuse among surgical patients is presented, and general institutional strategies that can be led by anaesthesiologists are offered, to identify gaps in knowledge, and offer directions for future research.
Journal ArticleDOI
Kaempferol protects against propacetamol-induced acute liver injury through CYP2E1 inactivation, UGT1A1 activation, and attenuation of oxidative stress, inflammation and apoptosis in mice
Ming-Shiun Tsai,Ying-Han Wang,Yan-Yun Lai,Hsi-Kai Tsou,Gan-Guang Liou,Jiunn-Liang Ko,Sue-Hong Wang +6 more
TL;DR: It is suggested that kaempferol protects the liver against propacetamol-induced injury through anti-oxidative, anti-inflammatory and anti-apoptotic activities.
References
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Chapter 9: Analysing Data and Undertaking Meta-Analyses
TL;DR: This extract is made available solely for use in the authoring, editing or refereeing of Cochrane reviews, or for training in these processes by representatives of formal entities of The Cochrane Collaboration.
Journal ArticleDOI
COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: Cloning, structure, and expression
Naduviladath Vishvanath Chandrasekharan,Hu Dai,K. Lamar Turepu Roos,Nathan K. Evanson,Joshua Tomsik,Terry S. Elton,Daniel L. Simmons +6 more
TL;DR: Comparison of canineCOX-3 activity with murine COX-1 and -2 demonstrates that this enzyme is selectively inhibited by analgesic/antipyretic drugs such as acetaminophen, phenacetin, antipyrine, and dipyrone, and is potently inhibited by some nonsteroidal antiinflammatory drugs.
Journal ArticleDOI
Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged.
TL;DR: Despite an increased focus on pain management programs and the development of new standards for pain management, many patients continue to experience intense pain after surgery and additional efforts are required to improve patients’ postoperative pain experience.
Journal ArticleDOI
The number needed to treat: a clinically useful measure of treatment effect.
Richard J. Cook,David L. Sackett +1 more
TL;DR: The relative benefit of an active treatment over a control is usually expressed as the relative risk, the Relative risk reduction, or the odds ratio, but for clinical decision making, it is more meaningful to use the measure "number needed to treat."
Journal ArticleDOI
Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials.
TL;DR: There is evidence that the combination of nonsteroidal antiinflammatory drugs with patient-controlled analgesia morphine offers some advantages over morphine alone, and a decrease in morphine consumption is not a good indicator of the usefulness of a supplemental analgesic.
Related Papers (5)
Management of postoperative pain: A clinical practice guideline from the american pain society, the american society of regional anesthesia and pain medicine, and the american society of anesthesiologists' committee on regional anesthesia, executive committee, and administrative council.
Roger Chou,Debra B. Gordon,Oscar A. de Leon-Casasola,Jack M. Rosenberg,Stephen W. Bickler,Timothy J. Brennan,Todd Carter,Carla L. Cassidy,Eva Chittenden,Ernest Degenhardt,Scott R. Griffith,Renee C.B. Manworren,Bill McCarberg,Robert R. Montgomery,Jamie D. Murphy,Melissa F. Perkal,Santhanam Suresh,Kathleen A. Sluka,Scott A. Strassels,Richard C. Thirlby,Eugene R. Viscusi,Gary A. Walco,Lisa Warner,Steven J. Weisman,Christopher L. Wu +24 more