Department of Anesthesia, Stanford University School of Medicine, California 94305-5640, USA.
Pain Pract. 2011 May-Jun;11(3):290-6. doi: 10.1111/j.1533-2500.2010.00426.x. Epub 2010 Nov 28.
This study's objective was to systematically review the literature to assess analgesic outcomes of intravenous (IV) acetaminophen for acute postoperative pain in adults.
We searched Medline and the Cochrane library (January 1, 2000 to January 17, 2010, date of last search) for prospective, randomized, controlled trials (RCTs) of IV acetaminophen vs. either an active comparator or placebo.
Sixteen articles from 9 countries published between 2005 and 2010 met inclusion criteria and had a total of 1,464 patients. Median sample size=54 patients (range 25 to 165) and median follow-up=1 day (range 1 hour to 7 days). Four of the 16 articles had 3 arms in the study. One article had 4 arms. As a result, 22 study comparisons were analyzed: IV acetaminophen to an active comparator (n=8 studies) and IV acetaminophen to placebo (n=14 studies). The RCTs were of high methodological quality with Jadad median score=5. In 7 of 8 active comparator studies (IV parecoxib [n=3 studies], IV metamizol [n=4], oral ibuprofen [n=1]), IV acetaminophen had similar analgesic outcomes as the active comparator. Twelve of the 14 placebo studies found that IV acetaminophen patients had improved analgesia. Ten of those 14 studies reported less opioid consumption, a lower percentage of patients rescuing, or a longer time to first rescue with IV acetaminophen. Formal meta-analysis pooling was not performed because the studies had different primary end points, and the IV acetaminophen dosing regimens varied in dose, and duration and timing.
In aggregate, these data indicate that IV acetaminophen is an effective analgesic across a variety of surgical procedures.
本研究的目的是系统地回顾文献，评估静脉注射（IV）扑热息痛治疗成人急性术后疼痛的镇痛效果。
我们检索了 Medline 和 Cochrane 图书馆（2000 年 1 月 1 日至 2010 年 1 月 17 日，最后检索日期），以评估 IV 扑热息痛与活性对照或安慰剂相比的前瞻性、随机、对照试验（RCT）。
9 个国家的 16 篇文章发表于 2005 年至 2010 年期间，符合纳入标准，共有 1464 名患者。中位数样本量=54 例（范围 25 至 165 例），中位数随访时间=1 天（范围 1 小时至 7 天）。16 篇文章中的 4 篇有 3 个研究组。一篇文章有 4 个研究组。因此，分析了 22 个研究比较：IV 扑热息痛与活性对照（n=8 项研究）和 IV 扑热息痛与安慰剂（n=14 项研究）。RCT 具有较高的方法学质量，Jadad 中位数评分为 5 分。在 8 项活性对照研究中的 7 项（IV 帕瑞昔布[3 项研究]、IV 甲灭酸[4 项研究]、口服布洛芬[1 项研究]）中，IV 扑热息痛与活性对照具有相似的镇痛效果。在 14 项安慰剂研究中的 12 项中，发现 IV 扑热息痛患者的镇痛效果得到改善。其中 14 项研究中的 10 项报告，与 IV 扑热息痛相比，阿片类药物消耗减少，需要解救的患者比例降低，或首次解救时间延长。由于研究具有不同的主要终点，并且 IV 扑热息痛的剂量、持续时间和时间不同，因此未进行正式的荟萃分析。
总的来说，这些数据表明，IV 扑热息痛在各种手术中都是一种有效的镇痛药物。
