Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Pain Pract. 2012 Feb;12(2):159-73. doi: 10.1111/j.1533-2500.2011.00476.x. Epub 2011 Jun 16.
Good surgical outcomes depend in part on good pain relief, allowing for early mobilization, optimal recovery, and patient satisfaction. Postsurgical pain has multiple mechanisms, and multimechanistic approaches to postoperative analgesia are recommended and may be associated with improved pain relief, lowered opioid doses, and sometimes a lower rate of opioid-associated side effects. Acetaminophen (paracetamol) is a familiar agent for treating many types of pain, including postsurgical pain. Oral acetaminophen has been shown to be safe and effective in a variety of acute pain models. Combination products using a fixed-dose of acetaminophen and an opioid have also been effective in treating postsurgical pain. Combination products with acetaminophen have demonstrated an opioid-sparing effect, which inconsistently results in a reduced rate of opioid-associated side effects. Intravenous (IV) acetaminophen and an opioid analgesic administered in the perioperative period may be followed by an oral acetaminophen and opioid combination in the postoperative period. Transitioning from an IV acetaminophen and opioid formulation to a similar but oral formulation of the same drugs appears to be a reasonable step in that both analgesic therapies are known to be safe and effective. For postsurgical analgesia with any acetaminophen product, patient education is necessary to be sure that the patient does not concurrently take any over-the-counter products containing acetaminophen and accidentally exceed dose limits.
良好的手术效果部分取决于良好的止痛效果，可以实现早期活动、最佳恢复和患者满意度。术后疼痛有多种机制，推荐采用多机制的术后镇痛方法，这可能与更好的疼痛缓解、降低阿片类药物剂量以及有时降低阿片类药物相关副作用的发生率有关。对乙酰氨基酚（扑热息痛）是一种用于治疗多种类型疼痛（包括术后疼痛）的常用药物。口服对乙酰氨基酚已被证明在多种急性疼痛模型中是安全有效的。使用固定剂量对乙酰氨基酚和阿片类药物的联合产品也已被证明可有效治疗术后疼痛。对乙酰氨基酚联合产品具有阿片类药物节约效应，这并不总是会降低阿片类药物相关副作用的发生率。围手术期给予静脉（IV）对乙酰氨基酚和阿片类镇痛药，随后可在术后给予口服对乙酰氨基酚和阿片类药物联合治疗。从 IV 对乙酰氨基酚和阿片类药物制剂转换为相同药物的类似但口服制剂似乎是合理的步骤，因为这两种镇痛疗法均已被证明是安全有效的。对于任何含有对乙酰氨基酚的产品的术后镇痛，需要对患者进行教育，以确保患者不会同时服用任何含有对乙酰氨基酚的非处方产品，并且意外超过剂量限制。
