Womack Army Medical Center, Fort Bragg, North Carolina.
Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Womack Army Medical Center, Fort Bragg, North Carolina.
Pain Med. 2017 Dec 1;18(12):2466-2473. doi: 10.1093/pm/pnw273.
The management of postoperative pain is a major health care issue. While the cost of intravenous acetaminophen (IVA) is significantly greater than its oral acetaminophen (OA) counterpart, less is known regarding comparative effectiveness of these routes. The purpose of this study was to determine whether perioperative IVA is equivalent in reducing postoperative pain compared with perioperative OA for laparoscopic cholecystectomy (LapChole).
Double-blinded, prospective, randomized placebo-controlled trial.
Womack Army Medical Center, Fort Bragg, North Carolina.
Adults (age > 18 years) active duty military, veterans, and beneficiaries receiving a laparoscopic cholecystectomy.
This study was conducted at Womack Army Medical Center (WAMC), Fort Bragg, North Carolina, between January 2013 and June 2015. Sixty-seven subjects with symptomatic cholelithiasis were randomly assigned to receive two doses (1,000 mg each) of either IVA or OA. A numerical rating scale (NRS) score of pain was obtained preoperatively and every six hours for 24 hours postoperation. The primary objective was to assess whether treatment groups had significantly different 24-hour postoperative sum of pain intensity differences (SPID24) using an analysis of covariance test.
Sixty subjects completed the study and were included in the analysis. Treatment groups did not differ in SPID24, even when controlling for age, gender, and preoperative pain levels (F(1,55) = 0.39, P = 0.54, partial η2 = 0.007), nor did 24-hour opioid consumption when controlling for age, gender, and operation time (F(1, 46) = 0.47, P = 0.50, partial η2 = 0.01). Furthermore, treatment groups were equally as likely to report average postoperative NRS scores of 4 or higher (β = 0.24, Exp(B) = 1.28, P = 0.68).
The results show no evidence of differences between IVA or OA in pain or opioid consumption among a sample of patients undergoing LapChole. Due to low sample size, these descriptive findings warrant larger studies, which may have a significant economic impact.
术后疼痛管理是一个主要的医疗保健问题。虽然静脉注射对乙酰氨基酚（IVA）的成本明显高于其口服对乙酰氨基酚（OA），但关于这些途径的比较效果知之甚少。本研究的目的是确定围手术期 IVA 是否与围手术期 OA 一样，可有效减轻腹腔镜胆囊切除术（LapChole）的术后疼痛。
双盲、前瞻性、随机安慰剂对照试验。
北卡罗来纳州布拉格堡的沃马克陆军医疗中心。
现役军人、退伍军人和接受腹腔镜胆囊切除术的受益人（年龄>18 岁）。
本研究于 2013 年 1 月至 2015 年 6 月在北卡罗来纳州布拉格堡的沃马克陆军医疗中心（Womack Army Medical Center，WAMC）进行。67 例有症状的胆石症患者被随机分配接受两次剂量（每次 1000mg）IVA 或 OA。在术前和术后 24 小时内每六小时使用数字评分量表（NRS）评分获得疼痛评分。主要目的是使用协方差分析检验评估治疗组在 24 小时术后总和疼痛强度差异（SPID24）是否存在显著差异。
60 名受试者完成了研究并纳入了分析。即使在控制年龄、性别和术前疼痛水平的情况下，治疗组在 SPID24 方面也没有差异（F(1,55) = 0.39，P = 0.54，偏 η2 = 0.007），当控制年龄、性别和手术时间时，24 小时阿片类药物消耗也没有差异（F(1,46) = 0.47，P = 0.50，偏 η2 = 0.01）。此外，治疗组报告术后平均 NRS 评分 4 分或更高的可能性相等（β=0.24，Exp（B）=1.28，P=0.68）。
结果表明，在接受 LapChole 的患者样本中，IVA 或 OA 在疼痛或阿片类药物消耗方面没有差异。由于样本量小，这些描述性发现需要更大的研究，这可能会产生重大的经济影响。
