Sin Billy, Koop Kimberly, Liu Michelle, Yeh Jun-Yen, Thandi Pardeep
1Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy, LIU Pharmacy, Brooklyn, NY; 2Department of Pharmacy, Division of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, NY; 3Arnold and Marie Schwartz College of Pharmacy, LIU Pharmacy, Brooklyn, NY; 4Drug Regulatory Affairs M.S. Program, Arnold and Marie Schwartz College of Pharmacy, LIU Pharmacy, Brooklyn, NY; and 5Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY.
Am J Ther. 2017 Jan/Feb;24(1):e12-e19. doi: 10.1097/MJT.0000000000000526.
The efficacy, safety, opioid-sparing effects, and cost-benefit analyses of intravenous (IV) acetaminophen (APAP) in treating renal colic remain controversial.
To evaluate the safety, efficacy, opioid-sparing effects, and cost-benefits of IV APAP in patients who present with renal colic in the emergency department (ED).
We systematically searched PubMed (January 1970 to April 2016).
Randomized controlled trials which evaluated IV APAP for renal colic in the ED were eligible. The clinical outcomes measured were change in pain scores from baseline, incidence of adverse events, use of rescue analgesia, and cost-benefits. Forest plots were constructed using the Mantel-Haenszel method in a random effect model to changes in pain scores from the baseline to designated intervals.
The analysis suggested a difference in pain reduction favoring IV APAP over morphine. IV APAP had a significant effect in pain reduction than IV morphine (difference in mean pain score reduction = 7.5 in a 100-point visual analog scale (VAS); 95% confidence interval [CI], 1.99-13.00; P = 0.008). There was mild-to-moderate study heterogeneity (I = 42%). No difference was observed when IV APAP was compared with intramuscular piroxicam for pain reduction (difference in mean pain score reduction = 0.17 in a VAS reduction ≥50% VAS; 95% CI, -0.22 to 0.57) and to intramuscular diclofenac (difference in mean pain score reduction = 0.00 in a numeric rating scale reduction ≥50%; 95% CI, -0.12 to 0.12). The analysis for nonsteroidal anti-inflammatory drugs versus IV APAP revealed no difference (difference in mean pain score reduction = 0.01 in a 100-point VAS; 95% CI, -0.10 to 0.13; P = 0.80).
In this meta-analysis, we found that data on the efficacy, safety, opioid-sparing effects, and cost-benefit analyses of IV APAP for renal colic were weak. Based on the available data, IV APAP should not be considered as an alternative to opioids or nonsteroidal anti-inflammatory drugs for the primary management of renal colic in the ED.
静脉注射对乙酰氨基酚（APAP）治疗肾绞痛的疗效、安全性、阿片类药物节省效应及成本效益分析仍存在争议。
评估静脉注射APAP对急诊科（ED）肾绞痛患者的安全性、疗效、阿片类药物节省效应及成本效益。
我们系统检索了PubMed（1970年1月至2016年4月）。
评估静脉注射APAP治疗ED肾绞痛的随机对照试验符合要求。测量的临床结局包括疼痛评分较基线的变化、不良事件发生率、急救镇痛药物的使用及成本效益。采用Mantel-Haenszel方法在随机效应模型中构建森林图，以显示从基线到指定时间间隔疼痛评分的变化。
分析表明，与吗啡相比，静脉注射APAP在减轻疼痛方面存在差异。静脉注射APAP在减轻疼痛方面比静脉注射吗啡有显著效果（在100分视觉模拟量表（VAS）中，平均疼痛评分降低的差异为7.5；95%置信区间[CI]，1.99 - 13.00；P = 0.008）。存在轻度至中度的研究异质性（I = 42%）。将静脉注射APAP与肌肉注射吡罗昔康比较减轻疼痛时未观察到差异（在VAS降低≥50%时，平均疼痛评分降低的差异为0.17；95% CI，-0.22至0.57），与肌肉注射双氯芬酸比较时也未观察到差异（在数字评分量表降低≥50%时，平均疼痛评分降低的差异为0.00；95% CI，-0.12至0.12）。非甾体抗炎药与静脉注射APAP的分析显示无差异（在100分VAS中，平均疼痛评分降低的差异为0.01；95% CI，-0.10至0.13；P = 0.80）。
在这项荟萃分析中，我们发现静脉注射APAP治疗肾绞痛的疗效、安全性、阿片类药物节省效应及成本效益分析的数据较为薄弱。基于现有数据，在ED中，静脉注射APAP不应被视为肾绞痛初始治疗中阿片类药物或非甾体抗炎药的替代药物。
