Guo Hongzhang, Wang Changde, He Yufang
Department of Orthopaedics, Gansu Provincial Hospital of TCM, 418# GuaZhou Road, Qi Li He Zone, Lanzhou, 730050, People's Republic of China.
The Third Hospital of Gansu Province, 736# Duan Jia Tan, Cheng Guan Zone, Lanzhou, 730030, People's Republic of China.
J Orthop Sci. 2018 Sep;23(5):793-800. doi: 10.1016/j.jos.2018.04.008. Epub 2018 Jun 14.
The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management.
Eligible studies were searched from electronic databases including PubMed, Web of Science, Embase (Ovid interface) and Cochrane Library (Ovid interface). The quality assessments were performed according to the Cochrane systematic review method. The assessed outcomes were including opioid consumption, pain scores, length of hospital stays and total occurrence of adverse events.
Among 832 records identified, six randomized controlled trials (RCTs) and five non-RCTs were eligible for data extraction and meta-analysis. According to the outcomes, the patients receive intravenous acetaminophen had less total opioid consumption after knee or hip artroplasty (SMD = -0.66; 95%CI, -1.13 to -0.20), but they did not obtain statistical improvement of postoperative pain control at postoperative day 0 (POD0, SMD = -0,15; 95%CI, -0.36 to 0.07), POD1(SMD = 0,12; 95%CI, -0.13 to 0.36), POD2 (SMD = -0,29; 95%CI, -0.70 to 0.12) and POD3 (SMD = -0,04; 95%CI, -0.49 to 0.41). Meanwhile, there were similar outcomes about the length of hospital stays in patients whether or not receiving intravenous acetaminophen (SMD = -0,05; 95%CI, -0.26 to 0.15). And, the total adverse effects occurrence also didn't show any significant difference between the acetaminophen group and control group (OR = 0.87; 95%CI, 0.57 to 1.33).
Perioperative intravenous acetaminophen use in multimodal analgesia could significantly reduce of total opioid consumption, but it did not contribute to decrease the average pain scores and shorten the length of hospital stays in total hip or knee arthroplasty.
本研究的目的是评估膝关节或髋关节置换术患者静脉注射对乙酰氨基酚是否可以减少阿片类药物的使用并改善疼痛管理。
从包括PubMed、科学网、Embase（Ovid界面）和Cochrane图书馆（Ovid界面）在内的电子数据库中检索符合条件的研究。根据Cochrane系统评价方法进行质量评估。评估的结果包括阿片类药物的使用、疼痛评分、住院时间和不良事件的总发生率。
在确定的832条记录中，六项随机对照试验（RCT）和五项非RCT符合数据提取和荟萃分析的条件。根据结果，接受静脉注射对乙酰氨基酚的患者在膝关节或髋关节置换术后的阿片类药物总消耗量较少（标准化均数差[SMD]=-0.66；95%置信区间[CI]，-1.13至-0.20），但在术后第0天（POD0，SMD=-0.15；95%CI，-0.36至0.07）、POD1（SMD=0.12；95%CI，-0.13至0.36）、POD2（SMD=-0.29；95%CI，-0.70至0.12）和POD3（SMD=-0.04；95%CI，-0.49至0.41）时，他们在术后疼痛控制方面没有获得统计学上的改善。同时，接受或未接受静脉注射对乙酰氨基酚的患者在住院时间方面有相似的结果（SMD=-0.05；95%CI，-0.26至0.15）。而且，对乙酰氨基酚组和对照组之间的总不良反应发生率也没有显示出任何显著差异（比值比[OR]=0.
