Effect of Intravenous Paracetamol on Opioid Consumption in Multimodal Analgesia After Lumbar Disc Surgery: A Meta-Analysis of Randomized Controlled Trials

Yin, Feng; Wang, Xiuhong; Liu, Fei

doi:10.3389/fphar.2022.860106

Cited by 5 publications

(19 citation statements)

References 46 publications

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“…Paracetamol is widely used in the management of acute and chronic pain [ 19 ], and its analgesic efficacy as a preemptive analgesia has already been well-recognized in patients undergoing lumbar discectomy [ 40 ], total abdominal hysterectomy [ 41 ], lower limb surgery [ 42 ], and cholecystectomy [ 43 ], whereas metamizole was successfully used in the management of pain after laparoscopic operations [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole

Stasiowski,

Lyssek-Boroń,

Zmarzły

et al. 2024

Pharmaceuticals

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Despite the possibility of postoperative pain occurrence, in some patients, vitreoretinal surgeries (VRSs) require performance of general anesthesia (GA). The administration of intraoperative intravenous rescue opioid analgesics (IROA) during GA constitutes a risk of perioperative adverse events. The Adequacy of Anesthesia (AoA) concept consists of an entropy electroencephalogram to guide the depth of GA and surgical pleth index (SPI) to optimize the titration of IROA. Preemptive analgesia (PA) using cyclooxygenase-3 (COX-3) inhibitors is added to GA to minimize the demand for IROA and reduce postoperative pain. The current analysis evaluated the advantage of PA using COX-3 inhibitors added to GA with AoA-guided administration of IROA on the rate of postoperative pain and hemodynamic stability in patients undergoing VRS. A total of 165 patients undergoing VRS were randomly allocated to receive either GA with AoA-guided IROA administration with intravenous paracetamol/metamizole or with preemptive paracetamol or metamizole. Preemptive paracetamol resulted in a reduction in the IROA requirement; both preemptive metamizole/paracetamol resulted in a reduced rate of postoperative pain as compared to metamizole alone. We recommend using intraoperative AOA-guided IROA administration during VRS to ensure hemodynamic stability alongside PA using both paracetamol/metamizole to reduce postoperative pain.

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Section: Discussionmentioning

confidence: 99%

The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole

Stasiowski,

Lyssek-Boroń,

Zmarzły

et al. 2024

Pharmaceuticals

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“…Lumbar disc herniation surgeries are procedures notably associated with postoperative pain [1,3]. The implementation of efficient strategies for managing postoperative pain has been shown to result in faster mobilization, increased patient satisfaction, and a decrease in complications [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…These strategies encompass several approaches, including neuraxial blocks, local infiltration analgesia, and fascial plane blocks. Additionally, the utilization of pharmacological medicines such as nonsteroidal agents, opioids, and gabapentinoids is encouraged [3,4]. Interfascial plane blocks, including the thoracolumbar interfascial plane (TLIP) block, erector spinae plane (ESP) block, and quadratus lumborum block (QLB), play a significant role in contemporary medical practice for enhancing post-spinal surgery pain management.…”

Section: Introductionmentioning

confidence: 99%

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Canikli Adıgüzel,

Akyurt,

Bahadır Altun

et al. 2023

JCM

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Introduction: The management of postoperative pain following lumbar disc herniation (LDH) surgery is crucial for the quality of recovery. The effectiveness of multimodal analgesia plans increases when interfascial plane blocks are included. This study sought to compare the analgesic efficacy of preoperative ultrasound-guided TLIP (thoracolumbar interfascial plane) blocks and posterior QLBs (quadratus lumborum blocks) in patients undergoing LDH surgery. Methods: Patients undergoing elective LDH surgery under general anesthesia were randomized into two groups: thoracolumbar interfascial plane block (Group T) and posterior quadratus lumborum block (Group Q). Block applications were performed 30 min before anesthesia induction. In the postoperative period, analgesia control was provided with a patient-controlled analgesia device. The patients’ 24 h cumulative opioid consumption was examined. Pain scores were evaluated in the 0th, 3rd, 6th, 9th, 12th, and 24th hours. Results: The mean 24 h cumulative morphine consumption for patients was statistically insignificant when Groups T and Q were compared (9.14 ± 7.03 mg vs. 8.66 ± 6.58 mg, p = 0.788). Pain scores at rest and during movement as well as morphine consumption were similar between groups in the 0th, 3rd, 6th, 9th, 12th, and 24th hours (p > 0.05). Conclusions: The study determined that the utilization of TLIP blocks and posterior QLBs prior to anesthesia induction yielded comparable outcomes in terms of reducing postoperative analgesic consumption and enhancing the efficacy of multimodal analgesia in individuals undergoing single-distance lumbosacral spine surgery under general anesthesia.

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“…Appendix 1 presents study selection details. We identified 1 systematic review 13 and 2 randomized controlled trials (RCTs) 14,15 that addressed the clinical effectiveness of IV acetaminophen for opioid-sparing (or reducing opioid consumption) in patients undergoing surgery. Appendix 5 provides additional references of potential interest that did not meet the inclusion criteria.…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…We identified 1 systematic review 13 and 2 RCTs 14,15 regarding the clinical effectiveness, specifically the opioidsparing effects, of IV Acetaminophen compared to relevant comparators.…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

Opioid-Sparing Effects of IV Acetaminophen for Patients Undergoing Surgery

Santos,

Lachance,

Bailey

2024

cjht

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What Is the Issue? Opioids are often used to help manage postoperative pain. However, their consumption can cause side effects, in addition to the risk of developing dependence with long-term use. Acetaminophen is an alternative analgesic that may provide opioid-sparing benefits for patients undergoing surgery (e.g., the need for patients to use opioids later), but there is a lack of synthesized evidence to confirm. Acetaminophen is available in different formulations, such as IV, oral, and rectal. However, there is uncertainty around the benefits of using 1 formulation over another perioperatively. What Did We Do? To inform decisions about IV acetaminophen, we sought to identify and summarize literature comparing the effectiveness of IV acetaminophen to alternative analgesics (i.e., nonsteroidal anti-inflammatory drugs [NSAIDs]), alternative formulations (i.e., oral or rectal acetaminophen), or placebo for reducing opioid consumption in patients undergoing surgery. A research information specialist conducted a literature search of peer-reviewed and grey literature sources published between January 1, 2019, and January 9, 2024. The search was limited to English-language documents. One reviewer screened articles for inclusion based on predefined criteria. To investigate the true effect of IV acetaminophen, we excluded studies with any intraoperative opioid use. What Did We Find? For adult patients undergoing elective hip surgery, there may be no significant differences in cumulative opioid use between postoperative IV and oral acetaminophen (1 randomized controlled trial). For patients undergoing elective cesarian delivery, postoperative IV acetaminophen may result in a decrease in total morphine consumption after surgery compared to placebo (1 randomized controlled trial). For adult patients undergoing lumbar disc surgery, there may be no significant differences in total morphine consumption for patients receiving intraoperative IV acetaminophen compared to placebo (1 systematic review with 1 relevant RCT). We did not find any studies comparing the opioid-sparing effects of IV acetaminophen to NSAIDs that met our criteria for this review. What Does It Mean? Limited evidence from this review suggests that the opioid-sparing effect of IV acetaminophen may vary across types of surgery when compared to placebo. Additionally, IV acetaminophen may not offer additional opioid-sparing benefits compared to oral administration. However, we require more comprehensive research with rigorous methodological approaches to understand this topic better. Relative to opioids, IV acetaminophen has a preferable side effect profile, including a low risk of dependence; therefore, decision-makers may wish to consider using this formulation in the surgical or postsurgical setting.

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Effect of Intravenous Paracetamol on Opioid Consumption in Multimodal Analgesia After Lumbar Disc Surgery: A Meta-Analysis of Randomized Controlled Trials

Cited by 5 publications

References 46 publications

The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole

The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Opioid-Sparing Effects of IV Acetaminophen for Patients Undergoing Surgery

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