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Plasma concentrations following repeated rectal or intravenous administration of paracetamol after heart surgery
Department of Cardiothoracic Surgery and Anaesthesiology Karolinska University Hospital Solna S-171 76 Stockholm.
2006 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 6, 673-677 p.Article in journal (Refereed) Published
Abstract [en]

Background:  Paracetamol is commonly used for post-operative pain management in combination with more potent analgesics. The best route of paracetamol administration after major surgery, when oral intake may not be optimal, is not known. Our primary purpose was to study plasma concentrations after the 1st and 4th dose of 1 g of paracetamol given either rectally or intravenously (i.v.) after major surgery.

Methods:  In this prospective, randomized study, 48 patients undergoing heart surgery were randomized upon arrival to the intensive care unit (ICU) to receive paracetamol every 6th hour either as suppositories or intravenous injections. In half the patients (n= 24), blood samples for paracetamol concentration were obtained before and 20, 40 and 80 min after the first dose. In the other patients (n= 24), additional samples were taken prior to, and at 20, 40, 80 min and 4 and 6 h after, the 4th dose.

Results:  Plasma paracetamol concentration peaked (95 ± 36 μmol/l) within 40 min after initial i.v. administration but did not increase within 80 min after the 1st suppository. Plasma concentration before the 4th dose was 74 ± 51 and 50 ± 27 in the rectal and i.v. groups, respectively. Paracetamol concentration peaked 20 min after the 4th dose for the i.v. patients (210 ± 84 μmol/l) and declined to 99 ± 27 μmol/l at 80 min as compared with the rectal patients 69 ± 44 to 77 ± 48 μmol/l.

Conclusion:  Both time course and peak plasma concentrations of paracetamol given rectally differ from the one seen after intravenous administration. The clinical impact of these differences needs further investigation.

Place, publisher, year, edition, pages
2006. Vol. 50, no 6, 673-677 p.
Keyword [sv]
paracetamol, suppositories, intravenous injections
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-358DOI: 10.1111/j.1399-6576.2006.01043.xOAI: oai:DiVA.org:rkh-358DiVA: diva2:552706
Note

Som manuskript i avhandling. As manuscript in dissertation.

Plasma concentrations following repeated rectal or intravenous administration of paracetamol after CABG

Available from: 2012-09-15 Created: 2012-09-15 Last updated: 2014-07-08Bibliographically approved
In thesis
1. Pain treatment after surgery: With special reference to patient-controlled analgesia, early extubation and the use of paracetamol
Open this publication in new window or tab >>Pain treatment after surgery: With special reference to patient-controlled analgesia, early extubation and the use of paracetamol
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The introduction of general anaesthesia eliminated pain during surgical operations. After surgery, however, pain and postoperative nausea and vomiting (PONV) have remained a persistent problem for many patients. The need for analgesics varies widely among patients, therefore standardised treatment protocols are often insufficient pain treatment. Our studies dealt with the incidence and severity of pain and PONV after cardiac surgery. Study aims were to use and develop techniques for better evaluation of analgesic needs – visual analogue scale (VAS; 0 to 10) – and to develop a multimodal treatment of pain with opioids administered by the patients themselves – Patient Controlled Analgesia (PCA) – combined with paracetamol. In 48 patients, PCA was compared to conventional Nurse Controlled Analgesia (NCA) on the ward after coronary artery bypass surgery. PCA led to lower VAS-scores, i.e. less pain, with the use of more opioids. In 57 patients, pain after heart surgery was compared for extubation “early” at 3 hours or “late” at 7 hours after surgery. VAS-scores, PONV and the amount of opioids used were similar whether patients were extubated early or late. Rectal and intravenous (i.v.) administration of paracetamol was compared in 28 patients after heart surgery with respect to its bioavailability after repeated doses. Plasma concentrations after the first dose were low with rectal administration. After the fourth dose at 24 hours they reached a plateau. With i.v. administration concentrations were higher both after the first and fourth dose. Oral and i.v. paracetamol was compared in 80 patients after heart surgery and in 35 patients after day surgery (hernia repairs etc). After heart surgery the use of opioids was less in the i.v. group but VAS-scores and PONV were similar. A majority of the patients scored higher than 3 once or more than once on the 10 degree VAS-scale. In the oral group after day surgery, the plasma concentration increased in a dose-dependent manner but the scatter was wide and unpredictable as compared to the i.v. group. Conclusions: PCA is a promising alternative to NCA for adequate pain treatment in the wards after heart surgery and is “by itself” adjusted to the needs of the individual patient. There is no risk that early extubation after cardiac surgery is followed by more postoperative pain. Intravenous paracetamol seems to have an opioid-sparing potential after heart surgery. Our routines must be further developed and more studies are needed to find an optimal regimen, since pain treatment sometimes was insufficient in many patients receiving the combined therapy.

Place, publisher, year, edition, pages
Stockholm: Repro Print, 2004. 50 p.
Keyword
acetaminophen, analgesia, patient-controlled, analgesics, day surgery, heart surgery, opioid, ketobemidone, pain measurement, pain, postoperative, paracetamol, postoperative nausea and vomiting, visual analogue scale
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-715 (URN)91-7140-134-2 (ISBN)
Public defence
2004-12-17, Thoraxklinikens aula, Karolinska Universitetssjukhuset, Stockholm, 09:00
Available from: 2014-07-08 Created: 2013-09-03 Last updated: 2014-07-08Bibliographically approved

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