Department of Pharmacy and 2 Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Box 420, Boston, MA 02129,USA.
Br J Anaesth. 2011 Jun;106(6):764-75. doi: 10.1093/bja/aer107. Epub 2011 May 9.
Paracetamol is the most commonly prescribed analgesic for the treatment of acute pain. The efficacy and safety of i.v. formulations of paracetamol is unclear. We performed a systematic search (multiple databases, bibliographies, any language, to May 2010) for single-dose, randomized, controlled clinical trials of propacetamol or i.v. paracetamol for acute postoperative pain in adults or children. Thirty-six studies involving 3896 patients were included. For the primary outcome, 37% of patients (240/367) receiving propacetamol or i.v. paracetamol experienced at least 50% pain relief over 4 h compared with 16% (68/527) receiving placebo (number needed to treat=4.0; 95% confidence interval, 3.5-4.8). The proportion of patients in propacetamol or i.v. paracetamol groups experiencing at least 50% pain relief diminished over 6 h. Patients receiving propacetamol or paracetamol required 30% less opioid over 4 h and 16% less opioid over 6 h than those receiving placebo. However, this did not translate to a reduction in opioid-induced adverse events (AEs). Similar comparisons between propacetamol or i.v. paracetamol and active comparators were either not statistically significant, not clinically significant, or both. AEs occurred at similar rates with propacetamol or i.v. paracetamol and placebo. However, pain on infusion occurred more frequently in those receiving propacetamol compared with placebo (23% vs 1%). A single dose of either propacetamol or i.v. paracetamol provides around 4 h of effective analgesia for about 37% of patients with acute postoperative pain. Both formulations are associated with few AEs, although patients receiving propacetamol have a higher incidence of pain on infusion.
对乙酰氨基酚是治疗急性疼痛最常用的处方镇痛药。静脉用对乙酰氨基酚制剂的疗效和安全性尚不清楚。我们对 2010 年 5 月之前的多数据库、文献目录和任何语种的单剂量、随机、对照临床试验进行了系统性检索，评估了用于成人或儿童急性术后疼痛的丙帕他莫或静脉用对乙酰氨基酚的疗效。共纳入 36 项研究，涉及 3896 例患者。主要终点为，与接受安慰剂的患者（68/527，16%）相比，接受丙帕他莫或静脉用对乙酰氨基酚的患者（240/367，37%）在 4 小时时至少有 50%疼痛缓解的患者比例更高（需要治疗的人数为 4.0；95%置信区间，3.5-4.8）。接受丙帕他莫或静脉用对乙酰氨基酚的患者在 6 小时时至少有 50%疼痛缓解的比例下降。与接受安慰剂的患者相比，接受丙帕他莫或对乙酰氨基酚的患者在 4 小时时需要的阿片类药物减少 30%，在 6 小时时需要的阿片类药物减少 16%。然而，这并没有转化为阿片类药物不良反应（AE）的减少。丙帕他莫或静脉用对乙酰氨基酚与活性对照药物之间的类似比较要么没有统计学意义，要么没有临床意义，要么两者均无。丙帕他莫或静脉用对乙酰氨基酚与安慰剂的 AE 发生率相似。然而，与安慰剂相比，接受丙帕他莫的患者输注时疼痛更常见（23% vs. 1%）。单次使用丙帕他莫或静脉用对乙酰氨基酚可为约 37%的急性术后疼痛患者提供约 4 小时的有效镇痛。两种制剂的 AE 发生率均较低，尽管接受丙帕他莫的患者输注时疼痛的发生率较高。
