Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran.
Halal Research Center of IRI, Food and Drug Administration, Tehran, Iran.
World Neurosurg. 2020 Feb;134:569-576. doi: 10.1016/j.wneu.2019.11.066. Epub 2019 Nov 20.
Acute pain control after supratentorial craniotomy is considered among the most important indicators of postoperative recovery. The aim of this study was to determine the effects of intravenous acetaminophen on postcraniotomy pain.
We searched databases including Embase, Scopus, Medline, Cochrane Library, and Web of Science until April 2019. Cochran Q test and I statistic were used to assess the heterogeneity across included clinical trials. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to estimate pooled effect sizes.
Out of 479 reports, 5 randomized controlled trials met the inclusion criteria and were appropriate for our meta-analysis, which included a total of 2635 patients. The pooled results of included clinical trials indicated that paracetamol intake significantly decreased rescue dose (SMD, -0.67; 95% CI, -1.15 to -0.19; P < 0.01; I = 90.0%), total dosage of rescue (SMD, -0.78; 95% CI, -1.18 to -0.37; P < 0.01; I = 86.0%), intensive care unit length of stay (SMD, -0.24; 95% CI, -0.44 to -0.04; P = 0.01; I = 0.0%), and visual analog scale score (SMD, -0.16; 95% CI, -0.31 to -0.00; P = 0.04; I = 71.7%) and increased patient satisfaction (SMD, 0.28; 95% CI, 0.14-0.43; P < 0.01; I = 10.2%) among patients with craniotomy. Time to rescue (SMD, 0.21; 95% CI, -0.42 to 0.85; P = 0.51; I = 94.3%) and hospital length of stay (SMD, -0.04; 95% CI, -0.24 to 0.16; P = 0.69; I = 0.0%) did not significantly change after paracetamol intake.
The results of this systematic review and meta-analysis indicate that preoperative intravenous administration of acetaminophen is associated with decreased postoperative pain, need for rescue analgesics, and dosages of analgesics after craniotomy surgery.
颅脑手术后的急性疼痛控制被认为是术后恢复的最重要指标之一。本研究旨在确定静脉用扑热息痛对颅脑手术后疼痛的影响。
我们检索了包括 Embase、Scopus、Medline、Cochrane 图书馆和 Web of Science 在内的数据库，检索时间截至 2019 年 4 月。使用 Cochran Q 检验和 I²统计量评估纳入临床试验的异质性。采用标准化均数差（SMD）和 95%置信区间（CI）来估计合并效应大小。
在 479 份报告中，有 5 项随机对照试验符合纳入标准，适合我们的荟萃分析，共纳入 2635 例患者。纳入临床试验的汇总结果表明，扑热息痛的摄入显著降低了解救剂量（SMD，-0.67；95%CI，-1.15 至-0.19；P<0.01；I²=90.0%）、解救总剂量（SMD，-0.78；95%CI，-1.18 至-0.37；P<0.01；I²=86.0%）、重症监护病房住院时间（SMD，-0.24；95%CI，-0.44 至-0.04；P=0.01；I²=0.0%）和视觉模拟评分（SMD，-0.16；95%CI，-0.31 至-0.00；P=0.04；I²=71.7%），并提高了颅脑手术患者的满意度（SMD，0.28；95%CI，0.14-0.43；P<0.01；I²=10.2%）。解救时间（SMD，0.21；95%CI，-0.42 至 0.85；P=0.51；I²=94.3%）和住院时间（SMD，-0.04；95%CI，-0.24 至 0.16；P=0.69；I²=0.0%）在扑热息痛摄入后没有显著变化。
本系统评价和荟萃分析的结果表明，术前静脉给予扑热息痛可降低颅脑手术后的疼痛、对解救性镇痛药物的需求以及术后镇痛药物的剂量。
