Use of Intravenous Acetaminophen in the Treatment of Postoperative Pain

Groudine, Scott B.; Fossum, Susan

doi:10.1016/j.jopan.2010.11.001

Cited by 31 publications

(15 citation statements)

References 31 publications

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“…Intravenous acetaminophen has a diverse and broad compatibility with other agents, making it a successful adjunct to other agents, additional NSAIDS, and opioids 14. It also synergistically has been shown to increase analgesic affect in multimodal analgesia 14,17…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Adding Parenteral Acetaminophen to Prochlorperazine and Diphenhydramine to Treat Headache in the Emergency Department

Meyering

Stringer

Hysell

2017

WestJEM

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IntroductionHeadaches represent over three million emergency department (ED) visits per year, comprising 2.4% of all ED visits. There are many proposed methods and clinical guidelines of treating acute headache presentations. However, data on intravenous acetaminophen usage in these settings are lacking. In this study, we sought to determine the efficacy of intravenous (IV) acetaminophen as an adjunct to a standard therapy for the treatment of patients who present to the ED with a chief complaint of “headache.”MethodsWe conducted a single site, randomized, double-blind, placebo-controlled trial investigating the clinical efficacy of IV acetaminophen as an adjunct to a standard therapy with prochlorperazine and diphenhydramine for the treatment of patients who present to the ED with a chief complaint of “headache” or variants thereof. (See below for variants). The primary outcome measure of the efficacy of parenteral acetaminophen as an adjunct treatment for headache in addition to a standard therapy was a threshold two-point reduction in visual analog scale (VAS) pain scores on a 1–10 level at 90 minutes. Secondary outcomes measures included assessment of decreased requirement of “rescue” pain medicines, defined as any analgesic medications outside of diphenhydramine, prochlorperazine and acetaminophen, with particular interest to potential opioid-sparing effects with parenteral acetaminophen. Additional secondary outcome measure included time to disposition from arrival in the ED.ResultsFor the acetaminophen group the initial mean pain score was 8.67, for the placebo group 8.61. At 90 minutes pain score was 2.23 for the acetaminophen group and 3.99 for placebo (p<0.01, 95% confidence interval (CI) [0.8%–16%]. Of 45 patients in each group, we observed at least a threshold two-point decrease in pain score 36/45 (80%) with acetaminophen vs. 25/45 (55%) with placebo (p <0.01) 95% CI [5%–41%], number needed to treat (NNT) = 4). Secondary outcome measure did not demonstrate a difference in length of stay (161 minutes for acetaminophen arm and 159 minutes for placebo). However, 17/45 (38%) of patients who received IV acetaminophen required rescue analgesia, opposed to 24/45 (53%) of patients in the placebo group (p=0.13) 95% CI [−5%–34%].ConclusionIV acetaminophen when used with prochlorperazine and diphenhydramine to treat acute headaches in the ED resulted in statistically significant pain reduction compared with prochlorperazine and diphenhydramine alone as measured by both threshold of lowering VAS pain score by at least two points (NNT = 4) and overall decline in VAS pain score. Further study is required to validate these results.

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Section: Discussionmentioning

confidence: 99%

Randomized Trial of Adding Parenteral Acetaminophen to Prochlorperazine and Diphenhydramine to Treat Headache in the Emergency Department

Meyering

Stringer

Hysell

2017

WestJEM

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“…Después de la exodoncia simple, los pacientes presentan efectos secundarios como el dolor posoperatorio e inflamación de los tejidos, razón por la que surgen nuevas estrategias de manejo del dolor con nuevas modalidades analgésicas, que pueden ir variando desde tratamientos que incluyen la monoterapia o terapia combinada, que consiste en asociar dos analgésicos para proporcionar un inicio rápido y una duración prolongada de la acción, al combatir el dolor en múltiples sitios de acción (5)(6)(7).…”

Section: Introductionunclassified

Efectividad analgésica del clonixinato de lisina asociado con el paracetamol en el tratamiento posoperatorio de exodoncias

Amaranto

Gómez

2019

Rev. Cienc. salud

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Introducción: el uso de terapias analgésicas para controlar el dolor postexodoncia es muy variado y depende muchos factores. El objetivo de este estudio fue comparar la efectividad analgésica del paracetamol asociado con el clonixinato de lisina y compararlo con monoterapias de paracetamol e ibuprofeno en el tratamiento posoperatorio de exodoncias. Materiales y métodos: la muestra estuvo conformada por 39 pacientes distribuidos aleatoriamente en tres grupos. El dolor posoperatorio se midió utilizando la Escala Visual Análoga (EVA) 1 h, 8 h y 24 h postexodoncia. El análisis estadístico de la evolución de las tres terapias, se realizó empleando el test t de Student, anova y test de Tuckey, con un nivel de significancia de p < 0.05. Resultados: los valores obtenidos demostraron que la combinación analgésica de paracetamol asociado con el clonixinato de lisina fue más efectiva 1 h y 8 h después. A las 24 h no existieron diferencias en los tres grupos de estudio. Conclusión: la analgesia de la terapia combinada de Paracetamol asociada con el Clonixinato de lisina es superior a la producida por la dosis estándar de Ibuprofeno y Paracetamol en el tratamiento del dolor posoperatorio de exodoncias simples.

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“…Recent studies have shown that non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen compounds are effective alternatives of opioids for pain control and improve patient compliance. Acetaminophen has been reported to have a proper suppressive effect on peripheral and central pain systems despite its low anti-inflammatory and anti-fever effects (2,8,12,13). Previous studies have mostly investigated the efficacy of traditional non-selective NSAIDs, including diclofenac, ibuprofen and ketorolac, for cox_2 inhibition.…”

Section: Introductionmentioning

confidence: 99%

“…It is administered as its tromethamine salt orally, intramuscularly, intravenously and as a topical ophthalmic solution. Clinical studies have indicated that a single-dose of ketorolac has a greater efficacy in controlling moderate to severe postoperative pain compared to morphine, pethidine (meperidine) and pentazocine (2,13,14). Studies have proved that the combination of acetaminophen and NSAIDs has greater analgesic effects than their individual administration (15).…”

Section: Introductionmentioning

confidence: 99%

Analgesic efficacy of morphine versus concurrent use of ketorolac and Acetaminophen in mandibular bone surgery

Mesgarzadeh¹,

Manshadi²,

Farnia³

2016

Int.J.Curr.Res.Aca.Rev.

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Background: Pain, a major issue in medical treatment, is one of the major concerns for both the clinician and the patient. Postoperative acute pain management during the initial hours is very important and can prevent side effects. Analgesics (acetaminophen, opioids) and nonsteroidal anti-inflammatory drugs are used as medications for pain control. Objective: This study was performed to compare the analgesic efficacy of morphine versus the concurrent use of ketorolac and intravenous acetaminophen after mandibular bone surgery. Materials and Methods: In this prospective, single-centered, randomized, double-blind clinical trial study, a total of 60 patients referred to Imam Reza Hospital in 2015 for mandibular bone surgery were randomized post-surgery into two groups: In group 1, acetaminophen (1 g in 100 cc normal saline solution) and ketorolac (30 mg in 100 cc normal saline solution) were infused every 6 hours. In group 2, morphine sulfate (0.1 mg/kg in 100 cc normal saline solution) was infused every 4 hours. The pain level was recorded on the visual analogue scale (VAS) at 1, 2, 4, 6, 12, and 24 hours after surgery. Results: Significant differences were found between the two groups in most hours. The mean pain level according to the VAS in group 1 and group 2 were 6.87±2.43 vs.7.20±2.06 (p = 0.560) for the 1 st hour post operation, 5.80±2.76 vs. 4.03±2.25 (p = 0.008) for the 2 nd hour post operation, 5.03±3.01 vs. 3.10±2.11 (p = 0.005) for the 4 th hour post operation, 3.37±3.03 vs. 1.77±1.92 (p = 0.017) for the 6 th hour post operation, 2.10±2.44 vs. 0.73±1.28 (p = 0.008) for the 12 th hour post operation and 1.30±1.91 vs. 0.60±1.28 (p = 0.101) for the 24 th hour post operation. No significant difference was observed in the 1 st and 24 th hour post-operation. Nausea was seen in the groups as one of the side effects with no significant difference. Conclusion: Morphine showed better efficiency in pain control than the concurrent use of ketorolac and intravenous acetaminophen.

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Use of Intravenous Acetaminophen in the Treatment of Postoperative Pain

Cited by 31 publications

References 31 publications

Randomized Trial of Adding Parenteral Acetaminophen to Prochlorperazine and Diphenhydramine to Treat Headache in the Emergency Department

Randomized Trial of Adding Parenteral Acetaminophen to Prochlorperazine and Diphenhydramine to Treat Headache in the Emergency Department

Efectividad analgésica del clonixinato de lisina asociado con el paracetamol en el tratamiento posoperatorio de exodoncias

Analgesic efficacy of morphine versus concurrent use of ketorolac and Acetaminophen in mandibular bone surgery

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