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Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting
Department of Surgical Sciences, Karolinska Institute, Stockholm.
Division of Anaesthesia, Sabbatsberg Day Surgical Centre, Stockholm.
Department of Surgical Sciences, Karolinska Institute, Stockholm.
2005 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 19, no 3, 306-309 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this study was to evaluate if intravenous acetaminophen compared to oral administration reduced the consumption of opioids and their side effects without an increase in pain during the stay in the intensive care unit (ICU).

Design: Prospective, randomized study.

Setting: An ICU in a university hospital.

Participants: Eighty patients with written informed consent undergoing coronary artery bypass grafting with cardiopulmonary bypass. Anesthesia was based on propofol and fentanyl combined with sevoflurane.

Interventions: Patients were randomized to 2 groups: acetaminophen, 1 g every sixth hour during the postoperative period, either as tablets or intravenously after extubation.

Measurements and Main Results: The amount of opioids administered during the study period was measured starting with acetaminophen administration during the stay in the ICU until 9 o'clock the following morning. Incidence of postoperative nausea and vomiting (PONV) was noted. Pain was evaluated with a visual analog scale (VAS) from 0 to 10. Three patients, 2 in the oral and 1 in the intravenous group, were excluded because of incomplete data. The intravenous group received less opioids than the orally treated group, 17.4 +/- 7.9 mg compared with 22.1 +/- 8.6 mg (p = 0.016). PONV incidence and VAS scores did not differ. During the first hours after extubation, 50 of 77 patients reported VAS scores >3 with no difference between groups.

Conclusions: Intravenous acetaminophen had a limited opioid-sparing effect when compared with oral administration after coronary artery bypass graft surgery. The opioid-sparing effect was not accompanied by any reduction in the incidence of PONV. The clinical significance of the opioid-sparing effect could therefore be questioned.

Place, publisher, year, edition, pages
2005. Vol. 19, no 3, 306-309 p.
Keyword [en]
postoperative pain, analgesia, ketobemidone, postoperative nausea and vomiting, acetaminophen
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-359DOI: 10.1053/j.jvca.2005.03.006PubMedID: 16130055OAI: oai:DiVA.org:rkh-359DiVA: diva2:552707
Note

Som manuskript i avhandling. As manuscript in dissertation.

Available from: 2012-09-15 Created: 2012-09-15 Last updated: 2014-11-07Bibliographically 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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