Clinical update on benefit versus risks of oral paracetamol alone or with codeine: still a good option?

Kress, Hans G.; Untersteiner, Gerald

doi:10.1080/03007995.2016.1254606

Cited by 7 publications

(6 citation statements)

References 135 publications

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“…Codeine is extensively used for the treatment of moderate pain. It is usually administered via oral route combined with paracetamol to exploit their synergistic effect (24,25). Tramadol can instead be used intravenously in the immediate postoperative period.…”

Section: Opioidsmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

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Section: Opioidsmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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“…It is often commercialized in association with non-opioid analgesics. The combination seems to possess higher analgesic potency and prolonged clinical effect than the single components [48]. The recommended posology per os is 30 mg with paracetamol 500 mg every 4 h. Despite its widespread use, no reports on thoracic surgery are available.…”

Section: Weak Opioidsmentioning

confidence: 99%

Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery

Umari

Carpanese

Moro

et al. 2017

European Journal of Cardio-Thoracic Surgery

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Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended. Loco-regional techniques such as the thoracic epidural and peripheral blocks can be performed. Several adjuvants have been employed with varying degrees of success both intravenously and in combination with local anesthetics. Opioids with different pharmacodynamic and pharmacokinetic profiles can be used, either through continuous infusion or on demand. Non-opioid analgesics are also beneficial. Finally, perioperative gabapentinoids may be implemented to prevent the onset of chronic neuropathic pain.

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“…5 Risk factors for paracetamol toxicity include older age, frailty, weight of ≤50 kg, malnourishment, presence of renal or liver impairment and hepatotoxic factors such as ethanol. 6,7 Keeping the above in mind, there is a need to rationalise the use of paracetamol in older adults and dose adjustments may be necessary. Existing guidelines do not have specific dosing recommendations on the use of paracetamol in the elderly.…”

Section: Introductionmentioning

confidence: 99%

“…7 In individuals with cirrhosis and those who consume regular alcohol, a maximum daily dose of 2-3g per day has been considered safe. 6,7 For individuals with severe renal impairment (creatinine clearance<30 mL/min), a dosing interval of at least 6 h is recommended. 7 There have been minimal studies to date on the use of paracetamol in elderly patients admitted for a fall.…”

Section: Introductionmentioning

confidence: 99%

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Is paracetamol prescribed appropriately in elderly patients admitted for a fall? – A Geriatrician’s perspective

Yap

Dhaliwal

Varman

2023

Proceedings of Singapore Healthcare

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Background Paracetamol is a commonly used analgesic among older adults. There have been reports of adverse events with chronic paracetamol use even at therapeutic doses. The objective of this clinical audit is twofold – 1. To evaluate the prevalence of inappropriate paracetamol prescription in the elderly admitted for falls; 2. To introduce strategies to reduce the rate of inappropriate paracetamol prescription in this population. Methods A clinical audit was performed on 100 patients aged 75 years and older who were admitted to the Geriatric Medicine department of a tertiary hospital between July 2019 and October 2019 with a primary diagnosis of a fall. Data collected included demographic data, relevant medical history of cirrhosis, cognitive impairment, alcohol use and weight <50 kg, prescription pattern of paracetamol on day 1 or two of admission and on discharge as well as clinical data on the documented indications for paracetamol use. Results Paracetamol was prescribed in 84 patients. Out of these 84 patients, 56 were prescribed round-the-clock paracetamol with a median duration of 9 (IQR = 10) days. In this group, paracetamol use was inappropriate in 32 (57%) of them and 32 (57%) patients were discharged with round-the-clock paracetamol for a median duration of 17.5 (IQR = 46) days. Conclusion This clinical audit revealed a high prevalence of round-the-clock and inappropriate paracetamol prescription in elderly patients admitted for a fall. Moving forward, we hope that the implementation of a paracetamol prescribing algorithm may reduce the rates of inappropriate paracetamol prescribing in this population.

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Clinical update on benefit versus risks of oral paracetamol alone or with codeine: still a good option?

Cited by 7 publications

References 135 publications

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery

Is paracetamol prescribed appropriately in elderly patients admitted for a fall? – A Geriatrician’s perspective

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