Single dose oral paracetamol (acetaminophen) for postoperative pain in adults

Toms, Laurence; McQuay, Henry J; Derry, Sheena; Moore, R Andrew

doi:10.1002/14651858.cd004602.pub2

Cited by 221 publications

(167 citation statements)

References 107 publications

(259 reference statements)

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“…An estimated 23% of all US adults consume a drug containing acetaminophen during an average week (Kaufman et al, 2002). Multiple randomized controlled trials document acetaminophen's analgesic proprieties, including clinically significant effects on dental, arthritic and postoperative pain (for reviews, see Hyllested et al, 2002;Perrott et al, 2004;Zhang et al, 2004;Toms et al, 2008;McNicol et al, 2011;De Oliveira et al, 2015). Acetaminophen also has analgesic effects in studies using experimental pain inductions, such as cold pressor, nasal dry air or thermal laser stimulation (e.g.…”

mentioning

confidence: 99%

From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain

Mischkowski

Crocker

Way

2016

Social Cognitive and Affective Neuroscience

124

108

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Simulation theories of empathy hypothesize that empathizing with others' pain shares some common psychological computations with the processing of one's own pain. Support for this perspective has largely relied on functional neuroimaging evidence of an overlap between activations during the experience of physical pain and empathy for other people's pain. Here, we extend the functional overlap perspective to the neurochemical level and test whether a common physical painkiller, acetaminophen (paracetamol), can reduce empathy for another's pain. In two double-blind placebocontrolled experiments, participants rated perceived pain, personal distress and empathic concern in response to reading scenarios about another's physical or social pain, witnessing ostracism in the lab, or visualizing another study participant receiving painful noise blasts. As hypothesized, acetaminophen reduced empathy in response to others' pain. Acetaminophen also reduced the unpleasantness of noise blasts delivered to the participant, which mediated acetaminophen's effects on empathy. Together, these findings suggest that the physical painkiller acetaminophen reduces empathy for pain and provide a new perspective on the neurochemical bases of empathy. Because empathy regulates prosocial and antisocial behavior, these drug-induced reductions in empathy raise concerns about the broader social side effects of acetaminophen, which is taken by almost a quarter of adults in the United States each week.

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confidence: 99%

From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain

Mischkowski

Crocker

Way

2016

Social Cognitive and Affective Neuroscience

124

108

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“…Multimodal analgesia in THA usually includes analgesics such as opioids, gabapentin, NSAIDs, acetaminophen, glucocorticoids, and local infiltration (Kardash et al 2008, Kerr and Kohan 2008, Toms et al 2008, Fredheim et al 2011, Maund et al 2011, Zhang et al 2011). …”

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confidence: 99%

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

et al. 2015

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Background and purpose — The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA.Patients and methods — 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day.Results — The levels of pain during mobilization—both in the recovery unit and on the day after surgery—and consumption of opioids on the first postoperative day were similar in the 2 groups.Interpretation — LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.

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“…The application and dosage of NSAIDs must strictly follow the recommendations, because the analgesic effect is limited, and higher doses may induce cardiac, renal, hemostatic, and gastrointestinal side effects [23]. The perioperative use of acetaminophen during major surgery is able to reduce the opioid demand, even if thoracotomy-specific evidence is still lacking [24][25][26][27][28][29][30][31]. Perioperative analgesic therapy with sNSAIDs remains controversial [32,33].…”

Section: Systemic Analgesiamentioning

confidence: 99%