Articles: acetaminophen.
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Case Reports
Use of fomepizole, n-acetylcysteine, and hemodialysis for massive acetaminophen overdose.
Acetaminophen poisoning is the leading cause of liver transplantation within the United States, accounting for nearly 56,000 emergency department patient visits each year. Although n-acetylcysteine is commonly successful in preventing acetaminophen toxicity when given in a timely manner, reports do exist demonstrating n-acetylcysteine therapy failure, commonly in the setting of a massive ingestion. We present the use of a novel antidote cocktail of n-acetylcysteine, fomepizole, and hemodialysis to treat a massive acetaminophen ingestion. ⋯ The patient was diagnosed with severe acetaminophen poisoning and was promptly administered n-acetylcysteine. Due to the severity of the patient's ingestion and the concern for additional coingestants, the patient was also given fomepizole therapy and later underwent hemodialysis for more rapid toxin clearance. After a four-day stay in the hospital the patient was discharged to a mental-health facility with no signs of systemic injury.
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Objective The primary objective was to evaluate if the administration of ibuprofen and acetaminophen at regularly scheduled intervals impacts pain scores and total opioid consumption, when compared to administration based on patient demand. Methods A retrospective chart review was performed comparing scheduled vs. as-needed acetaminophen and ibuprofen regimens, with 100 women included in each arm. ⋯ Acetaminophen and ibuprofen usage were also noted to be higher in this group while narcotic use was reduced by 64%. Conclusion Scheduled dosing of non-narcotic pain medications can substantially decrease opioid usage after cesarean delivery and improve post-operative pain.
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Introduction The association of pain and discomfort of moderate to high severity and a high incidence with the intravenous (IV) administration of propofol is well known. Various physical and pharmacological methods are used to minimize propofol-induced pain, but the best intervention is still unknown. Therefore, our aim was to determine the analgesic efficacy of IV paracetamol when used in combination with lidocaine pretreatment in reducing propofol injection pain. ⋯ The analgesic efficacy of group A was positive in 36 patients (97.3%), and for group B, the analgesic efficacy was positive in 24 patients (64.9%). Conclusion The administration of IV paracetamol with lidocaine pretreatment was more effective than lidocaine pretreatment alone in reducing the pain caused by the injection of propofol. Physicians should consider using IV paracetamol in combination with lidocaine pretreatment when patients require IV propofol to ease patient suffering and reduce pain, which may help provide optimal patient care.
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Acta Anaesthesiol Scand · Feb 2020
Randomized Controlled Trial Multicenter StudyBenefits and harm of paracetamol and ibuprofen in combination for postoperative pain: preplanned subgroup analyses of the multicenter randomized PANSAID trial.
The "Paracetamol and Ibuprofen in Combination" (PANSAID) trial showed that combining paracetamol and ibuprofen resulted in lower opioid consumption than each drug alone and we did not find an increase in risk of harm when using ibuprofen vs paracetamol. The aim of this subgroup analysis was to investigate the differences in benefits and harms of the interventions in different subgroups. We hypothesized that the intervention effects would differ in subgroups with different risk of pain or adverse events. ⋯ These pre-planned subgroup analyses did not suggest that patients in the investigated subgroups benefitted differently from a basic non-opioid analgesic regimen consisting of paracetamol and ibuprofen. Further, there was no evidence of subgroup heterogeneity regarding harm and use of ibuprofen. Because of reduced statistical power in subgroup analyses, we cannot exclude clinically relevant subgroup heterogeneity.
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Review Meta Analysis
Intravenous Acetaminophen (Paracetamol) for Post-Craniotomy Pain; Systematic Review and Meta-analysis of Randomized Clinical Trials.
Acute pain control after supratentorial craniotomy is considered among the most important indicators of postoperative recovery. The aim of this study was to determine the effects of intravenous acetaminophen on postcraniotomy pain. ⋯ The results of this systematic review and meta-analysis indicate that preoperative intravenous administration of acetaminophen is associated with decreased postoperative pain, need for rescue analgesics, and dosages of analgesics after craniotomy surgery.