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  • 1.
    Holmér Pettersson, Pia
    et al.
    Department of Surgical Sciences, Karolinska Institute, Stockholm.
    Jakobsson, Jan
    Division of Anaesthesia, Sabbatsberg Day Surgical Centre, Stockholm.
    Öwall, Anders
    Department of Surgical Sciences, Karolinska Institute, Stockholm.
    Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting2005In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 19, no 3, p. 306-309Article in journal (Refereed)
    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.

  • 2.
    Holmér Pettersson, Pia
    et al.
    Department of Surgical Sciences, Karolinska Institute, Division of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm.
    Settergren, Göran
    Department of Surgical Sciences, Karolinska Institute, Division of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm.
    Öwall, Anders
    Department of Surgical Sciences, Karolinska Institute, Division of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm.
    Similar pain scores after early and late extubation in heart surgery with cardiopulmonary bypass2004In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, ISSN 1053-0770, Vol. 18, no 1, p. 64-67Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate if early extubation, 2 hours after surgery, would result in more postoperative pain or in an increased use of opioid analgesics compared with late extubation, 6 hours after surgery.

    Design: Prospective, randomized study.

    Setting: Intensive care unit, university hospital.

    Participants: Sixty patients undergoing cardiac surgery with cardiopulmonary bypass.

    Interventions: Patients were randomized into 2 groups: extubation at about 2 (early) or 6 (late) hours. Anesthesia was based on propofol and remifentanil. There was no epidural analgesia and no local anesthesia in the wound. A bolus of the opioid ketobemidone was administered toward the end of surgery followed by a continuous infusion.

    Measurements and Main Results: Pain, provoked during deep breathing or coughing, evaluated with a visual analog scale (VAS) going from 0 to 10, was measured after extubation, and at 8 and 16 hours after surgery. Unprovoked pain was measured hourly. If VAS was greater than 3, the infusion rate was increased and a bolus of ketobemidone was given. Three patients in the late group were excluded because of incomplete data. Pain did not differ between the early and late groups at any time. In all patients, 21 never scored >3, 11 scored >3 once, and 25 scored >3 more than once. Nine patients had 1 score >5. The amount of ketobemidone was similar in both groups.

    Conclusions: Early extubation had no negative effect on the quality of postoperative pain control and was not followed by an increased use of analgesics.

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