Jebaraj Bright, Maitra Souvik, Baidya Dalim Kumar, Khanna Puneet
Department of Anaesthesiology & Intensive Care, AIIMS, F 35/2 Gautam Nagar, New Delhi 49, India.
Pain Res Treat. 2013;2013:402510. doi: 10.1155/2013/402510. Epub 2013 Nov 6.
Postoperative pain management is one of the most challenging jobs in orthopedic surgical population as it comprises of patients from extremes of ages and with multiple comorbidities. Though effective, opioids may contribute to serious adverse effects particularly in old age patients. Intravenous paracetamol is widely used in the postoperative period with the hope that it may reduce opioid consumption and produce better pain relief. A brief review of human clinical trials where intravenous paracetamol was compared with placebo or no treatment in postoperative period in orthopedic surgical population has been done here. We found that four clinical trials reported that there is a significant reduction in postoperative opioid consumption. When patients received an IV injection of 2 g propacetamol, reduction of morphine consumption up to 46% has been reported. However, one study did not find any reduction of opioid requirement after spinal surgery in children and adolescent. Four clinical trials reported better pain scores when paracetamol has been used, but other three trials denied. We conclude that postoperative intravenous paracetamol is a safe and effective adjunct to opioid after orthopedic surgery, but at present there is no data to decide whether paracetamol reduces opioid related adverse effects or not.
术后疼痛管理是骨科手术患者群体中最具挑战性的工作之一，因为该群体包含了年龄跨度极大且患有多种合并症的患者。尽管阿片类药物有效，但可能会导致严重的不良反应，尤其是在老年患者中。静脉注射对乙酰氨基酚在术后广泛使用，人们希望它可以减少阿片类药物的用量，并产生更好的疼痛缓解效果。本文对骨科手术患者群体术后将静脉注射对乙酰氨基酚与安慰剂或不进行治疗进行比较的人体临床试验进行了简要综述。我们发现，四项临床试验报告称术后阿片类药物的用量显著减少。当患者静脉注射2克丙帕他莫时，据报道吗啡用量减少了46%。然而，一项研究未发现儿童和青少年脊柱手术后阿片类药物需求量有任何减少。四项临床试验报告称使用对乙酰氨基酚后疼痛评分更佳，但另外三项试验则否定了这一点。我们得出结论，术后静脉注射对乙酰氨基酚是骨科手术后阿片类药物的一种安全有效的辅助药物，但目前尚无数据来确定对乙酰氨基酚是否能减少与阿片类药物相关的不良反应。
