Ghiculescu R A, Kubler P A, Gleeson P
Department of Clinical Pharmacology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Intern Med J. 2007 Sep;37(9):620-3. doi: 10.1111/j.1445-5994.2007.01391.x. Epub 2007 Jun 2.
I.v. paracetamol has recently become available in Australia for the treatment of pain when the oral or rectal administration route is not accessible. Our primary aim was to assess compliance with prescribing guidelines and our secondary aim to evaluate the safety of i.v. paracetamol use (4 g/day) and the effect of patient comorbidities on drug safety.
Eighty-five consecutive patients were identified through the pharmacy dispensing system at a 900-bed, metropolitan, primary care and tertiary referral hospital over a period of 7 months from December 2005 to June 2006. Cross-sectional evaluation by patient interview, review of medical records and pathology parameters were carried out. The study has been approved by the Royal Brisbane and Women's Hospital Human Research Ethics Committee.
I.v. paracetamol was given for pain following abdominal surgery (90%) and musculoskeletal pain (10%). The comorbid conditions included severe renal impairment (9.4%), alcohol dependence (3.5%), pre-existing liver failure (2.4%) and malnutrition (18.8%). Prescribing guidelines were not adhered to in 25% of patients. The main cause for discordance observed in 90% of this group was the administration of i.v. paracetamol despite the presence of an alternative route of administration. Eight patients received i.v. paracetamol despite not having had a surgical procedure. Twelve patients received i.v. paracetamol for longer than 48 h; no injection site reactions or toxicity were noted.
A lack of concordance between i.v. paracetamol use and prescribing guidelines was identified. There were no new safety concerns.
静脉注射对乙酰氨基酚最近在澳大利亚上市，用于在无法采用口服或直肠给药途径时治疗疼痛。我们的主要目的是评估对处方指南的依从性，次要目的是评估静脉注射对乙酰氨基酚（每日4克）的安全性以及患者合并症对药物安全性的影响。
通过一家拥有900张床位的大都市初级保健和三级转诊医院的药房配药系统，在2005年12月至2006年6月的7个月期间确定了85例连续患者。通过患者访谈、病历审查和病理参数进行横断面评估。该研究已获得皇家布里斯班和妇女医院人类研究伦理委员会的批准。
静脉注射对乙酰氨基酚用于腹部手术后疼痛（90%）和肌肉骨骼疼痛（10%）。合并症包括严重肾功能损害（9.4%）、酒精依赖（3.5%）、既往肝功能衰竭（2.4%）和营养不良（18.8%）。25%的患者未遵守处方指南。在该组90%的患者中观察到不符合规定的主要原因是尽管存在替代给药途径仍静脉注射对乙酰氨基酚。8例患者未进行手术却接受了静脉注射对乙酰氨基酚。12例患者静脉注射对乙酰氨基酚的时间超过48小时；未观察到注射部位反应或毒性。
确定静脉注射对乙酰氨基酚的使用与处方指南之间缺乏一致性。没有新的安全问题。
