Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A Randomized Controlled Trial

详细信息    查看全文

• 作者：Srdjan Jelacic ; MD^* ; ^{sjelacic@uw.edu" class="auth_mail" title="E-mail the corresponding author} ; Laurent Bollag ; MD^* ; Andrew Bowdle ; MD ; PhD^* ; Cyril Rivat ; PhD^* ; Kevin C. Cain ; PhD^&dagger ; ; Philippe Richebe ; MD ; PhD^*
• 关键词：intravenous acetaminophen ; cardiac surgery ; analgesia
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：30
• 期：4
• 页码：997-1004
• 全文大小：669 K

文摘

The authors hypothesized that intravenous acetaminophen as an adjunct analgesic would significantly decrease 24-hour postoperative opioid consumption.

Design

Double-blind, randomized, placebo-controlled trial.

Setting

A single academic medical center.

Participants

The study was comprised of 68 adult patients undergoing cardiac surgery.

Interventions

Patients were assigned randomly to receive either 1,000 mg of intravenous acetaminophen or placebo immediately after anesthesia induction, at the end of surgery, and then every 6 hours for the first 24 hours in the intensive care unit, for a total of 6-1,000 mg doses.

Measurements and Main Results

The primary outcome was 24-hour postoperative opioid consumption. The secondary outcomes included 48-hour postoperative opioid consumption, incisional pain scores, opioid-related adverse effects, length of mechanical ventilation, length of intensive care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48 hours postoperatively. The mean±standard deviation postoperative 24-hour opioid consumption expressed in morphine equivalents was significantly less in the acetaminophen group (45.6±29.5 mg) than in the placebo group (62.3±29.5 mg), representing a 27% reduction in opioid consumption (95% CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and opioid-related adverse effects between the 2 groups. A significantly greater number of patients in the acetaminophen group responded “very much” and “extremely well” when asked how their overall pain experience met their expectation (p = 0.038).

Conclusions

The administration of intravenous acetaminophen during cardiac surgery and for the first 24 hours postoperatively reduced opioid consumption and improved patient satisfaction with their overall pain experience but did not reduce opioid side effects.