The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona.
Star Urogynecology, Peoria, Arizona.
JSLS. 2021 Apr-Jun;25(2). doi: 10.4293/JSLS.2020.00104.
Despite limited data, acetaminophen, along with other agents, is commonly included in enhanced recovery after surgery (ERAS) protocols following laparoscopic hysterectomy. We aimed to systematically review the efficacy of acetaminophen on the management of postoperative pain after laparoscopic hysterectomy.
We searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases for relevant clinical trials investigating the role of acetaminophen in the management of pain after laparoscopic hysterectomy. We performed the risk of bias according to Cochrane's risk of bias tool. We performed the analysis of homogeneous data under the fixed-effects model during the analysis of heterogeneous data under the random-effects model. The primary outcome was the assessment of pain score after 2, 6, 12, and 24 h.
A total of 495 patients in 13 trials were included in our meta-analysis. Acetaminophen was not superior at reducing postoperative pain scores. Further analysis at progressive temporal points revealed no further significance; effect size at after 2 h (SMD = -0.020, 95% CI (-0.216; 0.176)), 6 h (SMD = -0.115, 95% CI (-0.312; 0.083)), 12 h (SMD = -0.126, 95% CI (-0.277; 0.025)), or 24 h (SMD = 0.063, 95% CI (-0.065; 0.191)). Pooled analysis was heterogeneous ( < 0.1); therefore, we conducted a sensitivity analysis yielding homogeneous results. The drug did not reduce opioid need (MD = -0.16, 95% CI (-2.39, 2.06), = 0.89).
We conclude that acetaminophen is not beneficial for reducing pain after laparoscopic hysterectomy. Other alternatives have better results. Caution should be given to the inclusion of acetaminophen in ERAS protocols designed for laparoscopic hysterectomy, especially as a single agent or to reduce opioid consumption.
尽管数据有限，但在腹腔镜子宫切除术后的加速康复外科（ERAS）方案中，通常会加入对乙酰氨基酚和其他药物。我们旨在系统地回顾对乙酰氨基酚在腹腔镜子宫切除术后管理术后疼痛的疗效。
我们在 PubMed、SCOPUS、Web of Science 和 Cochrane Library 数据库中搜索了关于对乙酰氨基酚在腹腔镜子宫切除术后疼痛管理中作用的临床试验。我们根据 Cochrane 的偏倚风险工具评估了偏倚风险。在异质性数据的分析中，我们采用随机效应模型，在同质性数据的分析中，我们采用固定效应模型。主要结局是评估术后 2、6、12 和 24 小时的疼痛评分。
共有 13 项试验中的 495 名患者纳入我们的荟萃分析。与安慰剂相比，对乙酰氨基酚在减轻术后疼痛评分方面没有优势。进一步按时间点进行分析也没有发现进一步的意义；术后 2 小时（SMD = -0.020，95%CI (-0.216；0.176)）、6 小时（SMD = -0.115，95%CI (-0.312；0.083)）、12 小时（SMD = -0.126，95%CI (-0.277；0.025)）或 24 小时（SMD = 0.063，95%CI (-0.065；0.191)）时的效应量没有统计学意义。汇总分析存在异质性（ < 0.1）；因此，我们进行了敏感性分析，结果具有同质性。该药并未减少阿片类药物的需求（MD = -0.16，95%CI (-2.39，2.06)， = 0.89）。
我们的结论是，对乙酰氨基酚对减轻腹腔镜子宫切除术后疼痛无益。其他替代品的效果更好。在设计用于腹腔镜子宫切除术的加速康复外科方案时，应谨慎考虑加入对乙酰氨基酚，尤其是作为单一药物或减少阿片类药物的使用。
