Articles: acetaminophen.
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Anesthesia and analgesia · Aug 1998
Randomized Controlled Trial Clinical TrialAcetaminophen as an adjunct to morphine by patient-controlled analgesia in the management of acute postoperative pain.
Opioids play a fundamental role in the management of postoperative pain, but their use is associated with a number of side effects, including nausea and vomiting, sedation, and respiratory depression. Co-administration of a nonopioid has been proposed as a method of reducing opioid intake and minimizing side effects. Sixty-one ASA physical status I and II patients were enrolled in a double-blind, randomized, placebo-controlled, parallel study to investigate the effect of a combination of acetaminophen and morphine after open reduction and internal fixation of acute limb fractures. Patients were randomized to receive either oral acetaminophen (1 g every 4 h) or placebo as an adjuvant to morphine by patient-controlled analgesia (PCA) postoperatively. They were assessed daily for 72 h or until the PCA was discontinued according to standardized guidelines. The outcome variables collected were pain scores (11-point scale), amount of morphine self-administered, duration of PCA use, compliance with study design, incidence of nausea and sedation, and overall patient satisfaction. The acetaminophen group had lower pain scores on Day 1 (2.1 vs 3.3; P = 0.03) and a shorter average duration of PCA use (35.8 vs 45.5 h; P = 0.03). Overall patient satisfaction was also significantly greater in the acetaminophen group (8.7 vs 7.9; P = 0.04). These data suggest that acetaminophen is a useful adjunct to morphine PCA. ⋯ This study assesses the benefit of combining two analgesics for the treatment of postoperative pain. Such a combination improves the quality of pain relief and patient satisfaction.
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We describe a patient in whom a manic episode was precipitated by use of panadeine forte, a preparation containing codeine and paracetamol. ⋯ Mania can be induced by large doses of Panadeine forte, particularly if there is a biological predisposition.
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The Committee on Infectious Diseases of the American Academy of Pediatrics recommends withholding antipyretic administration to patients with enteric fever because of the risk of shock developing as a consequence. ⋯ We did not find any complications associated with the use of acetaminophen or ibuprofen in children with enteric fever. The effects of antipyretics in enteric fever should be further studied.
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Letter Case Reports
Paracetamol-induced liver toxicity after intravenous administration.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain.
Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. ⋯ Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.