Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Anesthesiology and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2022 Jul;69(7):885-897. doi: 10.1007/s12630-022-02257-6. Epub 2022 May 10.
Hip fractures are debilitating in older adults because of their impact on quality of life. Opioids are associated with adverse effects in this population, so oral acetaminophen is commonly prescribed to minimize opioid use. Intravenous (iv) acetaminophen has been reported to have superior efficacy and bioavailability than oral acetaminophen. Nevertheless, its effect on postoperative outcomes in emergency hip fractures is unclear. This systematic review assessed the effect of iv acetaminophen on postoperative outcomes in older hip fracture patients.
We searched multiple databases from inception to June 2021 for studies on adults > 50 yr of age undergoing emergency hip fracture surgery who received iv acetaminophen (or paracetamol) and that reported postoperative outcomes. Relevant titles, abstracts, and full texts were screened based on the eligibility criteria. The Newcastle-Ottawa scale was used to assess the quality of the selected papers.
Of 3,510 initial studies, four met the inclusion criteria. One was a prospective cohort study and three were retrospective cohort studies. All four studies used historical control groups. Three studies reported a significantly lower mean opioid dose with iv acetaminophen than with oral acetaminophen. Three studies also reported a significantly shorter hospital stay. One study each reported a significant decrease in the number of missed physical therapy sessions, the need for one-to-one supervision, and episodes of delirium.
There is very limited low-level evidence that iv acetaminophen improves preoperative and postoperative analgesia and shortens hospital stay in older hip fracture patients. Nevertheless, our results should be interpreted with caution since there are no prospective randomized trials investigating whether iv acetaminophen improves postoperative outcomes in this patient population.
PROSPERO (CRD42021198174); registered 15 August 2021.
髋部骨折会对老年人的生活质量造成严重影响，因为它们会导致身体虚弱。在这一人群中，阿片类药物与不良反应相关，因此通常会开口服扑热息痛来尽量减少阿片类药物的使用。已有研究报道，静脉用（iv）扑热息痛的疗效和生物利用度优于口服扑热息痛。然而，其对急诊髋部骨折术后结果的影响尚不清楚。本系统评价评估了 iv 扑热息痛对老年髋部骨折患者术后结果的影响。
我们从创建到 2021 年 6 月在多个数据库中搜索了接受急诊髋部骨折手术且接受 iv 扑热息痛（或对乙酰氨基酚）治疗并报告术后结果的年龄大于 50 岁的成年人的研究。根据纳入标准筛选相关标题、摘要和全文。纽卡斯尔-渥太华量表用于评估所选论文的质量。
在 3510 项初始研究中，有 4 项符合纳入标准。其中 1 项为前瞻性队列研究，3 项为回顾性队列研究。这 4 项研究均使用了历史对照组。有 3 项研究报告称，与口服扑热息痛相比，iv 扑热息痛的平均阿片类药物剂量显著更低。3 项研究还报告称，住院时间明显缩短。有 1 项研究报告称，错过物理治疗课程的次数、一对一监督的需求以及谵妄发作的次数均显著减少。
有非常有限的低水平证据表明，iv 扑热息痛可改善老年髋部骨折患者的术前和术后镇痛效果，并缩短其住院时间。然而，由于没有前瞻性随机试验研究 iv 扑热息痛是否可以改善该患者人群的术后结果，因此我们的结果应谨慎解释。
PROSPERO（CRD42021198174）；注册于 2021 年 8 月 15 日。
