Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500HB Nijmegen, The Netherlands.
Anesth Analg. 2012 Dec;115(6):1451-6. doi: 10.1213/ANE.0b013e31826a4253. Epub 2012 Sep 13.
Paracetamol is a cornerstone for perioperative pain relief. Its mechanism of action may include a local anti-inflammatory effect with inhibition of cyclooxygenase isoenzymes. The scarce literature available on its effects on wound healing consists of preclinical studies into the effect of paracetamol on healing of the musculoskeletal system. Although the drug is used abundantly for pain relief after surgery of the gastrointestinal tract, there are no published data on the influence of paracetamol on anastomotic and abdominal healing. This also holds for the crucial, early inflammatory phase of repair. The recovery of wound strength could therefore conceivably be affected by paracetamol.
In 78 male Wistar rats, we constructed an anastomosis in colon and ileum. The rats received either low- or high-dose (50 or 200 mg/kg/d, divided over 2 doses) paracetamol or vehicle (controls) until they were killed on day 3 or 7 after surgery (n = 13 each). In anastomoses, the main outcome variables were 2 independent measures for wound strength, bursting pressure, and breaking strength, the latter being the primary outcome variable. In addition, collagen levels were measured and histology was performed. In fascia, breaking strength was analyzed.
No significant differences were found between control and paracetamol-treated groups at any time point for any of the variables. Wound strength increased significantly from day 3 to day 7 in all groups. In the colon anastomosis, the breaking strength increased from 130 ± 9 g (mean ± SEM) at day 3 to 232 ± 17 g at day 7 in the control group, from 144 ± 10 to 224 ± 9 g in the low-dose group, and from 130 ± 12 to 263 ± 28 g in the high-dose group. The lower limit for the 95% confidence interval was -11 for the difference between control and low-dose groups at day 3 and -25 for the difference between control and high-dose groups. No differences in collagen levels were found between the high-dose and control groups. Histology did not indicate the presence of gross differences between groups.
Perioperative use of paracetamol in a rat model of intestinal surgery does not significantly impede wound repair in the early postoperative period.
对乙酰氨基酚是围手术期缓解疼痛的基石。其作用机制可能包括局部抗炎作用，抑制环氧化酶同工酶。关于其对伤口愈合影响的可用文献很少，这些研究是关于对乙酰氨基酚对肌肉骨骼系统愈合的影响的临床前研究。尽管该药物在胃肠道手术后大量用于缓解疼痛，但尚无关于对乙酰氨基酚对吻合口和腹部愈合影响的发表数据。这同样适用于修复的关键早期炎症阶段。因此，伤口强度的恢复可能会受到对乙酰氨基酚的影响。
在 78 只雄性 Wistar 大鼠中，我们构建了结肠和回肠吻合术。大鼠接受低剂量（50mg/kg/d，分 2 次）或高剂量（200mg/kg/d，分 2 次）对乙酰氨基酚或载体（对照组）治疗，直到术后第 3 天或第 7 天处死（每组 13 只）。在吻合术中，主要观察指标是 2 种独立的伤口强度测量值，即破裂压和断裂强度，后者为主要观察指标。此外，还测量了胶原蛋白水平并进行了组织学检查。在筋膜中，分析了断裂强度。
在任何时间点，任何变量在对照组和对乙酰氨基酚治疗组之间均无显著差异。所有组的伤口强度均从第 3 天到第 7 天显著增加。在结肠吻合术中，对照组第 3 天的断裂强度从 130 ± 9g（平均值 ± SEM）增加到第 7 天的 232 ± 17g，低剂量组从 144 ± 10g 增加到 224 ± 9g，高剂量组从 130 ± 12g 增加到 263 ± 28g。第 3 天，对照组和低剂量组之间的差异下限为-11，对照组和高剂量组之间的差异下限为-25。高剂量组和对照组之间的胶原蛋白水平没有差异。组织学检查并未表明组间存在明显差异。
在肠道手术的大鼠模型中，围手术期使用对乙酰氨基酚不会显著阻碍术后早期的伤口修复。
