Does 1 or 2 g paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients?

Salonen, Arto J.; Silvola, Juha; Kokki, Hannu

doi:10.1111/j.1399-6576.2009.02035.x

Cited by 19 publications

(24 citation statements)

References 25 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Five randomized, placebo-controlled trials were identified; all compared intravenous acetaminophen with placebo. [31][32][33][34][35] The benefit of intravenous acetaminophen over its comparator in pain control and opioid consumption was not consistent across the studies. None of the studies found a significant difference in the rate of postoperative nausea and vomiting between treatment groups.…”

Section: Otolaryngologic Surgerymentioning

confidence: 98%

See 1 more Smart Citation

Clinical and Economic Evidence for Intravenous Acetaminophen

Yeh

Reddy

2012

Pharmacotherapy

View full text Add to dashboard Cite

Intravenous acetaminophen received United States Food and Drug Administration approval in November 2010 for the management of mild-to-moderate pain, management of moderate-to-severe pain with adjunctive opioid analgesics, and reduction of fever. Although intravenous acetaminophen generally improved pain relief and demonstrated opioid-sparing effects compared with placebo, it did not consistently reduce the frequency of opioid-related adverse events (e.g., postoperative nausea and vomiting). The safety and efficacy of intravenous acetaminophen as an antipyretic agent have been documented in adults and children; however, its cost is several-fold higher than that of the oral and rectal formulations. Although use of intravenous acetaminophen has reduced other postoperative resource utilization (e.g., hospital length of stay) in some studies outside the United States in patients undergoing abdominal surgery, a full economic evaluation in the United States has yet to be undertaken. In addition, its administration time (15-min infusion) and packaging (glass, single-use vial) have the potential to adversely affect patient flow in the postanesthesia care unit, create burden on patient care units, and lead to drug waste. Furthermore, 1 g of intravenous acetaminophen is formulated in 100 ml of solution, which may be an issue for patients with fluid restrictions. Given the clinical and economic evidence currently available, intravenous acetaminophen should not replace oral or rectal acetaminophen, but its use may be considered in a limited number of patients who cannot receive drugs orally and rectally and who cannot tolerate other parenteral nonopioid analgesic or antipyretic agents.

show abstract

Section: Otolaryngologic Surgerymentioning

confidence: 98%

“…Five randomized, placebo‐controlled trials were identified; all compared intravenous acetaminophen with placebo . The benefit of intravenous acetaminophen over its comparator in pain control and opioid consumption was not consistent across the studies.…”

Section: Clinical Trialsmentioning

confidence: 99%

Clinical and Economic Evidence for Intravenous Acetaminophen

Yeh

Reddy

2012

Pharmacotherapy

View full text Add to dashboard Cite

show abstract

“…At the same time, a national survey distributed across England, Wales, Scotland and Northern Ireland declared paracetamol, nonsteroidal anti-inflammatory drugs (NSAID's), strong opiates and antiemetics as the main analgesic modalities used after tonsillectomy surgery in children [1]. Intravenous paracetamol has been demonstrated to decrease the needed opioid doses after adenotonsillectomy when it has been combined with ketoprofen and administered intravenously at the end of the operation [14].…”

Section: Discussionmentioning

confidence: 99%

Rectal acetaminophen versus peritonsillar infiltration of bupivacaine for postoperative analgesia after adenotonsillectomy in children

Dahi-Taleghani

Mousavifard

Tahmoureszade

et al. 2010

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

There are a wide range of analgesic methods used for postoperative pain control in children undergoing elective adenotonsillectomy and there are many cases in which the postoperative analgesic modalities have not been fully successful to treat pain effectively. The acute postoperative analgesic effects of peritonsillar bupivacaine infiltration compared with rectal acetaminophen suppositories in elective adenotonsillectomy have been compared here. The methods employed were a single blind randomized clinical trail where 110 cases were selected to enter the study. After induction of anesthesia and intubation, and just before start of the procedure, the 1st group received 30 mg/kg of acetaminophen rectally; while, the 2nd group received 1 mg/kg peritonsillar bupivacaine infiltration around the tonsils. Throat pain at rest, after swallowing, after taking fluid and after soft food and also, parents' and nurses satisfaction regarding patient analgesia were compared. The results stated that there was no difference between the two groups regarding throat pain at rest, after swallowing, after taking fluid and after soft food and also, parents' and nurses' satisfaction. We concluded that when considering the feasibility of rectal acetaminophen, the results of the study suggest it superior due to minimal risks compared with local peritonsillar administration of bupivacaine for elective adenotonsillectomy of children.

show abstract

Section: Opioid‐sparing Effects Of Acetaminophen Combination Therapymentioning

confidence: 97%

“…In 114 tonsillectomy patients (ranging in age from 16 to 50 years), adding 1 or 2 g of IV acetaminophen to IV ketoprofen 1 mg/kg did not significantly reduce pain compared to ketoprofen alone, but acetaminophen patients consumed less rescue analgesia (27% less in the 1 g acetaminophen group, P = 0.023 and 38% less in the 2 g group, P = )0.002). 92 A randomized study of 87 patients undergoing elective breast surgery divided patients to receive 1 g IV acetaminophen or 1 g IV metamizol or placebo, all delivered 20 minutes before surgery and then 4, 10, and 16 hours after tend of the procedure. 93 No significant differences among groups was noted in rescue morphine consumption, but more IV acetaminophen patients did not receive any rescue medication compared to placebo patients (42% vs. 4%, respectively).…”

Section: Acetaminophen (Iv Paracetamol)mentioning

confidence: 99%

Continuous Multimechanistic Postoperative Analgesia: A Rationale for Transitioning from Intravenous Acetaminophen and Opioids to Oral Formulations

et al. 2011

View full text Add to dashboard Cite

Good surgical outcomes depend in part on good pain relief, allowing for early mobilization, optimal recovery, and patient satisfaction. Postsurgical pain has multiple mechanisms, and multimechanistic approaches to postoperative analgesia are recommended and may be associated with improved pain relief, lowered opioid doses, and sometimes a lower rate of opioid-associated side effects. Acetaminophen (paracetamol) is a familiar agent for treating many types of pain, including postsurgical pain. Oral acetaminophen has been shown to be safe and effective in a variety of acute pain models. Combination products using a fixed-dose of acetaminophen and an opioid have also been effective in treating postsurgical pain. Combination products with acetaminophen have demonstrated an opioid-sparing effect, which inconsistently results in a reduced rate of opioid-associated side effects. Intravenous (IV) acetaminophen and an opioid analgesic administered in the perioperative period may be followed by an oral acetaminophen and opioid combination in the postoperative period. Transitioning from an IV acetaminophen and opioid formulation to a similar but oral formulation of the same drugs appears to be a reasonable step in that both analgesic therapies are known to be safe and effective. For postsurgical analgesia with any acetaminophen product, patient education is necessary to be sure that the patient does not concurrently take any over-the-counter products containing acetaminophen and accidentally exceed dose limits.

show abstract

Does 1 or 2 g paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients?

Abstract: Combining paracetamol i.v. with ketoprofen at the end of tonsillectomy did not reduce the proportion of the patients requiring rescue analgesia, but the number of opioid doses was less in the add-on groups.

Cited by 19 publications

References 25 publications

Clinical and Economic Evidence for Intravenous Acetaminophen

Clinical and Economic Evidence for Intravenous Acetaminophen

Rectal acetaminophen versus peritonsillar infiltration of bupivacaine for postoperative analgesia after adenotonsillectomy in children

Continuous Multimechanistic Postoperative Analgesia: A Rationale for Transitioning from Intravenous Acetaminophen and Opioids to Oral Formulations

Contact Info

Product

Resources

About