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Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain.

Abstract

BACKGROUND

Paracetamol (acetaminophen) is the most commonly prescribed analgesic for the treatment of acute pain. It may be administered orally or intravenously. The efficacy and safety of intravenous (IV) formulations of paracetamol, IV paracetamol and IV propacetamol, compared with placebo and other analgesics, is unclear.

OBJECTIVES

To assess the efficacy and safety of IV formulations of paracetamol for treatment of postoperative pain in both adults and children.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE (1950 to May 2010), EMBASE (1980 to 2010, Week 18), LILACS (1992 to May 2010) and reference lists of retrieved articles.

SELECTION CRITERIA

Randomized, double-blind, placebo- or active-controlled single dose clinical trials of IV propacetamol or IV paracetamol for acute postoperative pain in adults or children.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the risk of bias and extracted data. We contacted study authors for additional information. We collected adverse event information from the studies.

MAIN RESULTS

Thirty-six studies (3896 participants) were included. Thirty-seven percent of participants receiving IV propacetamol/paracetamol experienced at least 50% pain relief over four hours compared with 16% of those receiving placebo (number needed to treat to benefit (NNT = 4.0; 95% confidence interval 3.5 to 4.8). The proportion of participants in IV propacetamol/paracetamol groups experiencing at least 50% pain relief diminished over six hours, as reflected in a higher NNT of 5.3 (4.2 to 6.7). Participants receiving IV propacetamol/paracetamol required 30% less opioid over four hours than those receiving placebo. However, this did not translate to a reduction in opioid-induced adverse events.Meta-analysis of efficacy comparisons between IV propacetamol/paracetamol and active comparators (opioids or nonsteroidal anti-inflammatories (NSAIDs)) were either not statistically significant, not clinically significant, or both.Adverse events occurred at similar rates with IV propacetamol or IV paracetamol and placebo. However, pain on infusion occurred more frequently in those receiving IV propacetamol versus placebo (23% versus 1%).Meta-analysis did not demonstrate statistically significant differences between IV propacetamol/paracetamol and active comparators for any adverse event except a reduction in the rate of hypotension versus NSAIDs and a reduction in the rate of gastrointestinal disorders versus opioids.

AUTHORS' CONCLUSIONS

A single dose of both IV propacetamol and IV paracetamol provides around four hours of effective analgesia for about 37% of patients with acute postoperative pain. Both formulations are associated with few adverse events, although patients receiving IV propacetamol have a higher incidence of pain on infusion than both placebo and IV paracetamol.

Authors+Show Affiliations

Department of Anesthesiology, Tufts Medical Center, 800 Washington street, Boston, Massachusetts, USA, 02111.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

21975764

Citation

Tzortzopoulou, Aikaterini, et al. "Single Dose Intravenous Propacetamol or Intravenous Paracetamol for Postoperative Pain." The Cochrane Database of Systematic Reviews, 2011, p. CD007126.
Tzortzopoulou A, McNicol ED, Cepeda MS, et al. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database Syst Rev. 2011.
Tzortzopoulou, A., McNicol, E. D., Cepeda, M. S., Francia, M. B., Farhat, T., & Schumann, R. (2011). Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. The Cochrane Database of Systematic Reviews, (10), CD007126. https://doi.org/10.1002/14651858.CD007126.pub2
Tzortzopoulou A, et al. Single Dose Intravenous Propacetamol or Intravenous Paracetamol for Postoperative Pain. Cochrane Database Syst Rev. 2011 Oct 5;(10)CD007126. PubMed PMID: 21975764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. AU - Tzortzopoulou,Aikaterini, AU - McNicol,Ewan D, AU - Cepeda,M Soledad, AU - Francia,Marie Belle D, AU - Farhat,Tamman, AU - Schumann,Roman, Y1 - 2011/10/05/ PY - 2011/10/7/entrez PY - 2011/10/7/pubmed PY - 2011/11/4/medline SP - CD007126 EP - CD007126 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 10 N2 - BACKGROUND: Paracetamol (acetaminophen) is the most commonly prescribed analgesic for the treatment of acute pain. It may be administered orally or intravenously. The efficacy and safety of intravenous (IV) formulations of paracetamol, IV paracetamol and IV propacetamol, compared with placebo and other analgesics, is unclear. OBJECTIVES: To assess the efficacy and safety of IV formulations of paracetamol for treatment of postoperative pain in both adults and children. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE (1950 to May 2010), EMBASE (1980 to 2010, Week 18), LILACS (1992 to May 2010) and reference lists of retrieved articles. SELECTION CRITERIA: Randomized, double-blind, placebo- or active-controlled single dose clinical trials of IV propacetamol or IV paracetamol for acute postoperative pain in adults or children. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias and extracted data. We contacted study authors for additional information. We collected adverse event information from the studies. MAIN RESULTS: Thirty-six studies (3896 participants) were included. Thirty-seven percent of participants receiving IV propacetamol/paracetamol experienced at least 50% pain relief over four hours compared with 16% of those receiving placebo (number needed to treat to benefit (NNT = 4.0; 95% confidence interval 3.5 to 4.8). The proportion of participants in IV propacetamol/paracetamol groups experiencing at least 50% pain relief diminished over six hours, as reflected in a higher NNT of 5.3 (4.2 to 6.7). Participants receiving IV propacetamol/paracetamol required 30% less opioid over four hours than those receiving placebo. However, this did not translate to a reduction in opioid-induced adverse events.Meta-analysis of efficacy comparisons between IV propacetamol/paracetamol and active comparators (opioids or nonsteroidal anti-inflammatories (NSAIDs)) were either not statistically significant, not clinically significant, or both.Adverse events occurred at similar rates with IV propacetamol or IV paracetamol and placebo. However, pain on infusion occurred more frequently in those receiving IV propacetamol versus placebo (23% versus 1%).Meta-analysis did not demonstrate statistically significant differences between IV propacetamol/paracetamol and active comparators for any adverse event except a reduction in the rate of hypotension versus NSAIDs and a reduction in the rate of gastrointestinal disorders versus opioids. AUTHORS' CONCLUSIONS: A single dose of both IV propacetamol and IV paracetamol provides around four hours of effective analgesia for about 37% of patients with acute postoperative pain. Both formulations are associated with few adverse events, although patients receiving IV propacetamol have a higher incidence of pain on infusion than both placebo and IV paracetamol. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/21975764/Single_dose_intravenous_propacetamol_or_intravenous_paracetamol_for_postoperative_pain_ L2 - https://doi.org/10.1002/14651858.CD007126.pub2 DB - PRIME DP - Unbound Medicine ER -