Acetaminophen Group Research Articles

Effects of acetaminophen use on mortality of patients with acute respiratory distress syndrome: secondary data mining based on the MIMIC-IV database.

Acetaminophen is a commonly used analgesic after surgery, and its impact on prognosis in patients with acute respiratory distress syndrome (ARDS) has not been studied. This study explores the association between the use of acetaminophen and the risk of mortality in patients with ARDS. In this retrospective cohort study, 3,227 patients with ARDS who had or had not received acetaminophen were obtained from the Medical Information Mart for Intensive Care IV, patients were divided into acetaminophen and non- acetaminophen groups. In-hospital mortality of ARDS patients was considered as primary end point. We used univariate and multivariate Cox regression analyses to assess the relationship of acetaminophen use and in-hospital mortality in patients with ARDS. Subgroup analysis was performed according to age, gender, and severity of ARDS. Of the total patients, 2,438 individuals were identified as acetaminophen users. The median duration of follow-up was 10.54 (5.57, 18.82) days. The results showed that the acetaminophen use was associated with a decreased risk of in-hospital mortality [hazard ratio (HR) = 0.67, 95% confidence interval (CI): 0.57-0.78]. Across various subgroups of patients with ARDS based on age, gender, and severity, acetaminophen use exhibited an association with reduced risk of in-hospital mortality. Acetaminophen use was associated with in-hospital mortality of patients with ARDS. Acetaminophen therapy may represent a promising therapeutic option for ARDS patients and warrants further investigation.

Effect of acetaminophen use on GABA, NMDA, and synaptic plasticity-related genes in the immature mouse brain: A preliminary study

Abstract Background/aim: Acetaminophen is frequently used as an analgesic during pregnancy. The purpose of the present study was to evaluate the effects of acetaminophen administered to pregnant mice on the fetal brain, attention, memory, and learning functions in the postnatal period, and genetic mechanisms in these mice. Materials and methods: The study was designed with two different groups. The first group consisted of pregnant mice that were injected with acetaminophen, while the second group was comprised of pregnant mice that were injected with saline. 1st, 2nd, and 3rd days of pregnancy, one of the mice was injected subcutaneously with 100 mg/kg acetaminophen, and the other mouse was injected subcutaneously with 0.9% saline. On the 21st day after birth, five female and five male mice were randomly selected for the experimental and control groups. Behavioral tests were performed on mice at 2 months of age. In addition, changes in the transcript levels of 93 genes were evaluated by Real-Time PCR in the hippocampus. Results: The control group showed more interest in the new object than the acetaminophen group (p=0.002). In the marble burying test, greater burying activity was observed in the control group than in the acetaminophen group (p=0.0345). No significant difference was observed between the control and acetaminophen groups in the social interaction and tail suspension tests. GABRG3, GRM3, PICK1, CEBPB, and EGR4 mRNA expression levels increased in the acetaminophen group (0.0317, 0.0159, 0.0069, 0.0457, 0.015, p value respectively). Conclusions: Prenatal acetaminophen exposure affected both behavioral tests and transcript levels. Therefore, the potential effects of prenatal acetaminophen exposure should be carefully investigated.

Evaluation of the Effects of TENS Therapy and Acetaminophen on Pain Alleviation in Initial Orthodontic Treatment.

This prospective study aimed to evaluate the analgesic effects of acetaminophen and Transcutaneous Electric Nerve Stimulation (TENS) therapy for pain control. Forty orthodontic patients who underwent fixed orthodontic treatment were randomly assigned to one of 3 groups: (1) acetaminophen, (2) TENS therapy, or (3) control. Pain was evaluated at 12, 24, 36, and 48 hours after the placement of both 0.014" NiTi and 0.016" NiTi archwires using a 10 cm visual analogue scale (VAS). Because the data were found to be non-normal, Kruskal-Wallis test was employed for both stage I and stage II intra-group comparisons. For both stage I and stage II, evaluation of the VAS scores for all 3 groups at different time intervals showed that the difference between groups A and B was statistically insignificant (p>0.05). The scores of Group A compared to Group C were significant, and Group B compared to Group C showed significant values. Both TENS and acetaminophen reduced the pain experienced by patients compared with the placebo group. The acetaminophen group showed VAS results similar to those of the TENS group.

Adolescent Acetaminophen and Ibuprofen Self-Poisoning, 2017-2022.

Acetaminophen and ibuprofen are the most common agents involved in adolescent self-poisoning. With increasing suicidality observed during the COVID-19 pandemic, we sought to compare overdose trends, severity, and outcomes for both agents. We performed a retrospective analysis of the National Poison Data System for acetaminophen and ibuprofen single-substance exposures in teenagers 13-19 years of age from 2017-2022. Acetaminophen and ibuprofen overdoses (per 100,000 persons) were plotted by year. Medical outcomes, clinical effects, and therapies were compared to determine if there were differences in overdose severity between the 2 agents. From 2017 to 2022, US poison centers recorded 50,902 single-substance acetaminophen exposures and 41,674 single-substance ibuprofen exposures in teenagers. Cases peaked in 2021 with 40.0 versus 29.1 cases (per 100,000 persons) for acetaminophen and ibuprofen, respectively. Acetaminophen self-poisoning was significantly more likely to result in death (odds ratio, 13.92; 95% confidence interval, 2.18-581.75; P < 0.001) or inpatient admission (odds ratio, 7.38; 95% confidence interval, 7.10-7.66; P < 0.001) compared with ibuprofen. Abdominal pain and vomiting were the most common clinical effects for both agents, and unsurprisingly, acetaminophen was more likely to cause transaminitis and liver dysfunction, whereas ibuprofen was more likely to cause central nervous system depression and metabolic acidosis. For the acetaminophen group, 19 teenagers underwent organ transplantation. Given the increased hospitalization and treatment resources needed for acetaminophen overdoses compared with ibuprofen, it is time to implement acetaminophen packaging policy change to protect US adolescents.

Pre-Emptive Acetaminophen for Postoperative Pain (PAPP): An Updated Meta-Analysis

PurposePostoperative pain is a common consequence of surgery. Pre-emptive analgesia involves the initiation of analgesics prior to surgical incision. This has been proposed as a simple method to help reduce postoperative pain, which may be more effective in higher-risk populations such as cervical spine surgery. A previous meta-analysis has demonstrated that pre-emptive acetaminophen may be effective in reducing postoperative pain although the certainty of evidence was limited. This present paper is an updated meta-analysis comparing pre-emptive acetaminophen versus postincision acetaminophen in adult patients undergoing surgery. DesignSystematic review and meta-analysis with the inclusion of an unpublished randomized, placebo-controlled, double-blind trial. MethodsAn updated meta-analysis was conducted which searched electronic databases to identify randomized controlled trials with the same interventions. FindingsWe included 845 participants and 12 studies in the updated meta-analysis. The meta-analysis (including our trial) found reduced 24-hour morphine consumption in the pre-emptive group (mean difference −2.42 mg; 95% confidence interval −4.26 to −0.59 mg), as well as reduced postoperative vomiting (risk ratio 0.56; 95% confidence interval 0.36 to 0.88). There was no difference between pre-emptive acetaminophen and control groups for time to analgesic request, pain scores at 6 and 24 hours or pruritis. For all outcomes assessed, there was very low certainty of evidence. ConclusionsThis meta-analysis found pre-emptive acetaminophen reduced 24-hour opioid consumption and postoperative vomiting.

Outcomes after hip fracture surgery in patients receiving non-steroidal anti-inflammatory drugs alone, acetaminophen alone, or both.

The use of multimodal non-opioid analgesia in hip fractures, specifically acetaminophen combined with non-steroidal anti-inflammatory drugs (NSAIDs), has been increasing. However, the effectiveness and safety of this approach remain unclear. This study aimed to compare postoperative outcomes among patients with hip fractures who preoperatively received either acetaminophen combined with NSAIDs, NSAIDs alone, or acetaminophen alone. This nationwide retrospective cohort study used data from the Diagnosis Procedure Combination database. We included patients aged ≥ 18 years who underwent surgery for hip fractures and received acetaminophen combined with NSAIDs (combination group), NSAIDs alone (NSAIDs group), or acetaminophen alone (acetaminophen group) preoperatively, between April 2010 and March 2022. Primary outcomes were in-hospital mortality and complications. Secondary outcomes were opioid use postoperatively; readmission within 90 days, one year, and two years; and total hospitalization costs. We used propensity score overlap weighting models, with the acetaminophen group as the reference group. We identified 93,018 eligible patients, including 13,068 in the combination group, 29,203 in the NSAIDs group, and 50,474 in the acetaminophen group. Propensity score overlap weighting successfully balanced patient characteristics among the three groups, with no significant difference in in-hospital mortality rates observed among the groups (combination group risk difference 0.0% (95% CI -0.5 to 0.4%); NSAIDs group risk difference -0.2% (95% CI -0.5 to 0.2%)). However, the combination group exhibited a significantly lower risk of in-hospital complications than the acetaminophen group (risk difference -1.9% (95% CI -3.2 to -0.6%)) as well as a significantly lower risk of deep vein thrombosis (risk difference -1.4% (95% CI -2.2 to -0.7%)). Furthermore, total hospitalization costs were higher in the NSAIDs group than in the acetaminophen group (difference USD $438 (95% CI 249 to 630); p < 0.001). No significant differences in other secondary outcomes were observed among the three groups. The combination of acetaminophen with NSAIDs appears to be safe and advantageous in terms of reducing in-hospital complications.

Chewing Bite Wafers versus Conventional Analgesic Drugs to Relieve Self-Reported Pain Associated with Fixed Orthodontic Appliances: A Systematic Review and Meta-Analysis

(1) Objectives: To estimate the impact of chewing bite wafers in reducing pain associated with fixed orthodontic treatment (OT) compared with conventional analgesic drugs (CADs) (Ibuprofen or Acetaminophen). (2) Materials and methods: Unrestricted and manual searching was achieved up to November 2023 and PRISMA guidelines were followed. Randomized controlled trials (RCTs) were included. Meta-analyses were conducted using a random-effects model. The available evidence quality was considered using the GRADE approach. (3) Results: Seven RCTs were included. Five RCTs used the Visual Analog Scale for self-reported pain assessment, while two RCTs used the Numeric Rating Scale. Four RCTs had a high RoB, and three RCTs had a moderate RoB. Separate meta-analyses were performed by pooling quantitative data from two RCTs that compared self-reported orthodontic pain between the bite wafer and Ibuprofen groups and three RCTs that compared the bite wafer and Acetaminophen groups for the different timepoints after orthodontic treatment. None of the timepoints individually indicated a significant difference in pain scores between the bite wafer and control groups, except on day 3, indicating significantly lower pain scores in the bite wafer versus the Acetaminophen groups. The overall level of evidence was very low. (4) Conclusions: Chewing bite wafers is possibly a useful option for CADs to relieve pain during early fixed OT.

Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review

BackgroundParenteral ketorolac and intravenous (IV) acetaminophen have been used for prehospital analgesia, yet limited data exist on their comparative effectiveness. Study ObjectivesTo evaluate the comparative effectiveness of IV acetaminophen and parenteral ketorolac for analgesia in the prehospital setting. MethodsWe conducted a retrospective cross-sectional evaluation of patients receiving IV acetaminophen or parenteral ketorolac for pain management in a large suburban EMS system between 1/1/2019 and 11/30/2021. The primary outcome was change in first to last pain score. Subgroup analysis was performed on patients with traumatic pain. We used inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to estimate the treatment effect of acetaminophen versus ketorolac among all patients and the subgroup of those with traumatic pain. ResultsOf 2178 patients included, 856 (39.3%) received IV acetaminophen and 1322 (60.7%) received parenteral ketorolac. The unadjusted mean change in pain score was −1.9 (SD 2.4) for acetaminophen group and −2.4 (SD 2.4) for ketorolac. In the propensity score analyses, there was no statistically significant difference in pain score change for the acetaminophen group versus ketorolac among all patients (mean difference, IPTW: 0.11, 95% confidence interval [CI] −0.16, 0.37; PSM: 0.15, 95% CI −0.13, 0.43) and among those with traumatic pain (unadjusted: 0.18, 95% CI −0.35, 0.72; IPTW: 0.23, 95% CI −0.25, 0.71; PSM: −0.03, 95% CI −0.61, 0.54). ConclusionsWe found no statistically significant difference in mean pain reduction of IV acetaminophen and parenteral ketorolac for management of acute pain.

Postoperative pain management using an intravenous combination of ibuprofen and acetaminophen compared with acetaminophen alone after thyroidectomy: A prospective randomized controlled trial.

Multiple medications are more effective than single agents for postoperative pain management. We investigated the analgesic effects of an intravenous combination of acetaminophen and ibuprofen immediately after thyroidectomy. In this double-blind clinical trial, 62 patients who underwent thyroidectomies were randomized to either the treatment (1000 mg acetaminophen, 300 mg ibuprofen) or control (1000 mg acetaminophen) group. Postoperative pain intensity was assessed using the visual analog scale (VAS) 0, 15, and 30 min after recovery room admission. Opioid rescue consumption was also recorded. The VAS scores were significantly lower in the treatment than in the control group 15 [3 (2-4.3) vs. 5 (3-6); p = 0.015] and 30 [3 (2-4.3) vs. 4 (3-5); p = 0.018] min after recovery room admission, as were the opioid rescue dose requirements (p = 0.033). Combined intravenous acetaminophen and ibuprofen may be better than acetaminophen alone for immediately acute postoperative pain after thyroidectomy.

Hepatoprotective effect of amifostine and WR-1065 on acetaminophen-induced liver toxicity on Wistar rats.

The most important problem with acetaminophen is its hepatotoxicity. N-acetylcysteine (NAC) is used to treat the hepatotoxicity of acetaminophen. Due to the structural similarities of this compound with amifostine, we decided to test the effect of this substance and its metabolite, WR-1065, on the hepatotoxicity of acetaminophen. The single-dose method contained 1. Control; 2. Acetaminophen (1 g/kg, gavage); 3-5. Acetaminophen + amifostine (100, 200, 400 mg/kg, i.p.); 6-8. Acetaminophen + WR-1065 (50, 100, 200 mg/kg, i.p.); and 9. Acetaminophen + NAC (100, 200 mg/kg, i.p.). The multiple-dose method included the same groups: amifostine (50, 100, 200 mg/kg), WR-1065 (25, 50, 100 mg/kg), and NAC (100 mg/kg). Then, animals were sacrificed, and blood samples were collected for measuring ALT, AST, ALP, and T-Bil, liver tissue for histopathological examination, MDA, and GSH amounts. Acetaminophen increased the levels of MDA, T-Bil, ALT, AST, and ALP, decreased GSH levels, and augmented necrosis, neutrophils, lymphocytes, and macrophages in the port space in single-dose and multiple-dose studies. Amifostine and WR-1065 significantly reduced the levels of MDA, T-Bil, ALT, AST, ALP, increased GSH content, and ameliorated histopathological alterations in a single-dose and multiple-dose method compared to the acetaminophen group. Moreover, NAC caused a significant decrease in the levels of MDA, T-Bil, ALT, AST, and ALP, and reduced GSH amounts in single-dose and multiple-dose studies. Amifostine and WR-1065 as antioxidant and hepatoprotective compounds are effective in reducing acetaminophen-induced hepatotoxicity with a similar effect to NAC and can be administered as an adjunct in the treatment of acetaminophen overdose.

Comparison of the Effects of Ketorolac and Acetaminophen on RANK-L Levels in the Gingival Crevicular Fluid during Orthodontic Tooth Movement: A Pilot Study

Background: Patients usually present pain due to the release of different inflammatory mediators such as prostaglandin E2 and RANK-L. Analgesics such as acetaminophen and ketorolac can inhibit RANK-L expression and this can affect orthodontic treatment by decreasing bone remodeling and slowing orthodontic dental movement. Several studies have reported a decrease in dental movement after administering some non-steroidal anti-inflammatory drugs. Proposal: The objective was to evaluate the RANK-L levels and a possible modulation by administering acetaminophen and ketorolac in patients starting orthodontic treatment. Methodology: A double-blind, randomized clinical trial was carried out with 24 subjects divided into three study groups: calcined magnesia as a placebo, acetaminophen, and ketorolac. Gingival crevicular fluid was obtained at four time points: before pharmacological intervention, at 24 h, at 48 h, and on the 5th day. RANK-L concentrations were evaluated through ELISA analysis. Also, interproximal space generated by the elastic separator at the end of the study was recorded in the different study groups using the visual analog scale. Results: An increase in RANK-L at 24 h was observed in the placebo group compared to the ketorolac and acetaminophen groups. However, no significant differences were observed in the interproximal space at day 5 in the three study groups. Conclusion: Patients who do not take analgesics at the start of orthodontic treatment have higher levels of RANK-L. Therefore, the use of ketorolac or acetaminophen could decrease bone remodeling and interfere with orthodontic dental movement.

Hepatoprotective Effect of Merlot Grape Pomace Extract against Acetaminophen-Induced Damage in Mouse

This study investigated the benefits of Merlot grape pomace extract (EBUM) in experimental acetaminophen-induced intoxication. Swiss mice received the respective treatments for 7 days: Control (saline), Silymarin (100 mg/Kg), EBUM: 100 mg/Kg and 500 mg/Kg. On the seventh day, the acetaminophen control,Silymarin and EBUM received a single dose of acetaminophen 500 mg/kg. After 24 hours, the mice were sacrificed, the blood and liver were collected for analysis of serum transaminases (ALT and AST), bilirubin, hepatic markers of oxidative stress and histopathological analysis. EBUM was able to prevent acetaminophen-induced hepatic necrosis with a significant reduction (p&lt;0.0001) in ALT and AST, bilirubin, as well as a significant increase in hepatic GSH and CAT levels. The histological data are consistent with the transaminase results, showing less liver damage in the treated groups when compared to the acetaminophen group. The results allow us to infer that EBUM has a hepatoprotective effect against intoxication caused by acetaminophen in animal model, proving to be a therapeutic alternative in preventing drug-induced liver damage.

Comparison of acetaminophen with ibuprofen in the treatment of patent ductus arteriosus in neonates admitted to training hospitals in Khorramabad from 2018 to 2022: A retrospective study

Background: Due to the possible complications of a persistent ductus arteriosus (PDA), the treatment of the PDA will be necessary, depending on the opinion of the treating physician. Medical or surgical treatment can be used in this regard. In recent years, acetaminophen has been considered a medication with fewer potential side effects. The present study aimed to compare acetaminophen with ibuprofen in the patent ductus arteriosus in neonates admitted to training hospitals in Khorramabad. Materials and Methods: A total of 28 neonates were included in this retrospective cohort study. The required data were collected by studying the patients' files. The PDA in newborns was diagnosed by primary echocardiography by the attending physician. Thereafter, 12 and 16 cases were treated with ibuprofen and acetaminophen, respectively. After completing the treatment period on days 3 and 5, the attending physician performed echocardiography to check PDA closure. Data were analyzed in SPSS software (version 24) using descriptive indices of mean, standard deviation, frequency, percentage, Fisher's exact test, and Mann-Whitney U test. Results: In this study, the frequency of affected male neonates was the same as that of affected female newborns (n=14; 50%). The mean weight scores of neonates in acetaminophen and ibuprofen groups were obtained at 2831/25±918/49 and 2241/5 ±868/9 gr, respectively. All newborns in both groups were treated; thereafter, 23 cases recovered with 3-day treatment and 5 neonates with 5-day treatment. No significant complications were observed in patients. Conclusion: The effect of acetaminophen on PDA closure was similar to that of ibuprofen. The need for 5-day treatment was higher in the acetaminophen group; nonetheless, no significant side effects were reported in any newborn. According to this study, acetaminophen can be a good alternative to ibuprofen in the treatment of PDA.

Postnatal acetaminophen exposure and neurodevelopmental outcomes at 18-21 months corrected gestational age in preterm infants

Studies have reported prenatal acetaminophen exposure is associated with abnormal neurodevelopment. There is limited and conflicting data on neurodevelopmental outcomes following postnatal acetaminophen exposure. Our objective was to investigate the neurodevelopmental outcomes of preterm infants < 29 weeks gestation postnatally exposed to acetaminophen. Retrospective cohort study of infants born between 2008 and 2017 at a tertiary care perinatal center. Exclusion criteria included chromosomal disorders, major congenital abnormalities, and congenital infections. The primary outcome was a composite score of <85 on the cognitive, language, or motor components of the Bayley Scales of Infant and Toddler Development, 3rd edition, assessed at 18 to 21 months corrected gestational age. Multivariate logistic regression was used to assess confounders. Of the 945 infants included in the study, 120 were in the acetaminophen group. There was no difference in any of Bayley-III cognitive, language or motor composite scores of < 85 between the two groups for postnatal acetaminophen exposure, adjusted odds ratios (aORs) 1.03, 95% CI 0.60-1.78, or days of acetaminophen use, aORs 1.10, 95% CI 0.93-1.29. There was no difference in neurodevelopmental outcome between the acetaminophen exposed and non-exposed groups. Our results need validation in larger cohorts. Animal research and cohort studies have suggested that prenatal acetaminophen exposure may be associated with an elevated risk of neurobehavioral abnormalities. However, there is limited and conflicting research on the impact of postnatal acetaminophen on neurodevelopment. The results of this study suggest that postnatal acetaminophen does not negatively impact neurodevelopment at 18 to 21 months in preterm infants born at <29 weeks gestational age. While these results need validation in larger and more longitudinal studies, this study provides reassurance for the use of postnatal acetaminophen in extremely preterm infants.

Risk of Hyponatremia after Tramadol/Acetaminophen Single-Pill Combination Therapy: A Real-World Study Based on the OMOP-CDM Database.

Tramadol has been reported to cause hyponatremia but the evidence is conflicting. The risk of hyponatremia resulting from combination oral tramadol/acetaminophen (TA) therapy is thus unknown. This study examined whether, compared with acetaminophen (AA), TA use is associated with an increased risk of hyponatremia. Hospital data compatible with the Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM; version 5.3) for 30,999 patients taking TA or AA from 2011 through 2020 were analyzed. New-onset hyponatremia was defined as a serum sodium level <135mEq/L within 10days after drug initiation. The incidence rate ratio was calculated based on crude and 1:1 propensity-score-matched models. Subgroup analyses compared patients taking TA extended-release (TA-ER) and TA immediate-release (TA-IR) formulations. Among the 30,999 patients, 12,122 (39.1%) were aged >65years and 16,654 (53.7%) were male. Hyponatremia within 10days developed in 1613 (8.4%) of the 19,149 patients in the TA group; the incidence rate was higher than in the AA group (4.2%; 493 out of 11,850 cases). In the propensity-score-matched model, the incidence rate of hyponatremia in the TA group was 6.8 per 1000 person-days (PD), which was 1.57-fold (1.31, 1.89) higher than that in the AA group (4.3 per 1000 PD). In both the crude and propensity-score-matched models, the incidence rate of hyponatremia was significantly higher in the TA-ER than TA-IR subgroup. In this real-world study, hyponatremia was more frequently observed in the TA than AA group, and in the TA-ER than TA-IR subgroup. Therefore, it is imperative to prescribe tramadol cautiously and closely monitor electrolyte levels.

Comparison of Topical Anesthesia, Intracameral 1% Lignocaine and Topical Anesthesia and Intravenous Acetaminophen and Topical Anesthesia for Phacoemulsification in Cataract Surgery

Objective: To compare the effectiveness of topical Proparacaine 0.5%, topical Proparacaine 0.5% and topical Proparacaine 0.5% for intraoperative analgesia and surgeon’s score undergoing simple cataract surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan,from Sep 2022 to Mar 2023. Methodology: Sixty patients aged 40 years and more, ASA-l and ll, undergoing elective simple cataract surgeries were observed by taking 20 patients in all three groups (n=20). Group-T: Topical Anesthesia group, 0.5% Proparacaine Group-I: Topical Anesthesia &amp; Intracameral 1% Lignocaine Group-A: Topical Anesthesia and IV Acetaminophen groups were randomly allocated for pretreatment to either receive the 0.5% Proparacaine Eye drops (Group-T) or 0.5%Proparacaine eye drops with Intracameral 1ml 1% Lignocaine (I group) or 0.5% Proparacaine Eye drops with intravenous Acetaminophen 15ml/kg (A group). Incidence of pain by Visual analogue scale/wong-baker faces scale was noted. The surgeon’s comfort was assessed by using Gupta’s surgeon score questionnaire. Results: The results showed Group-I had better analgesic score than Group-T with only 1(5%) patient had a score of 4 but even more significant efficacy of intravenous acetaminophen plus topical anesthesia (Group-A) was shown as compared to rest of the groups with none (0%) patient had a VAS score of 4 (p-value=0.002). The results also showed Group-I had better surgeon comfort score than both Group-T and Group-A, with only 1(5%) patient had a score of 7 or above as compared to Group-T, 9(45%) patients and Group-A 7(35%) patients. (p-value=0.005). Conclusion: Intravenous acetaminophen plus topical

Hepatoprotective and Nephroprotective Effects of Haronga (Harungana madagascariensis) in Combination with Antioxidant Compounds in Albino Spraque Dawley Rats

Aim: The aim of this study was to evaluate the effects of Harungana madagascariensis stem bark ethyl acetate extract with antioxidants on the liver and kidney in rats.&#x0D; Study Design: Experimental.&#x0D; Place and Duration of Study: Department of Veterinary Pharmacology and Toxicology, University of Ibadan (from January-February, 2020).&#x0D; Methodology: This was done using Albino rats (Wistar) grouped into 12 of 5 animals per group for protective studies,ethyl acetate extract (EHM) of the plant at 100mg/kg, 200mg/kg and 500mg/kg in combination with each of Ascorbic acid (200mg/kg), Selenium (1mg/kg) and/or Allopurinol (50mg/kg). Group I-III are control groups, IV-VI EHM/Ascorbic acid, groups VII-IX EHM/Se, and groups X-XII EHM/AL. The combination were administered for 8 days prior acetaminophen (800mg/kg) on day 9. Animals were sacrificed on day 10 and samples were collected for biochemical and histopathological evaluations.&#x0D; Results: The study showed that acetaminophen induced-stress on the liver and kidney causing increase in liver biomarkers such as the aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphate (ALP), creatinine, blood urea, total protein and gamma-glutamyl transferase (GGT). The combination of H. madagasacariensis Ethyl acetate extract with Ascorbic acid, Allopurinol and/or Selenium at different doses causes protective effects by reducing the release of biomarkers and stabilized the elevated enzymes level shown in acetaminophen group. The histopathology of the liver in the acetaminophen group showed moderate portal congestion with mild periportal cellular infiltration and a moderate to severe portal fibrosis, while the kidney showed severe diffuse tubular degeneration and necrosis.&#x0D; Conclusion: The EHM (500 mg/kg and 200 mg/kg) in combination with Ascorbic acid, Allopurinol or Selenium protected the liver and kidney from injury induced by Acetaminophen. The Ethyl acetate extract (EHM) of the plant showed synergy with Ascorbic acid, Selenium and Allopurinol to prevent injury on both organs.

Comparison of the Effect of Injectable Acetaminophen with Injectable Ketamine by Morphine Pump on Reducing Acute Pain after Laparoscopic Cholecystectomy Surgery

Introduction: At the issues that have always been the concern of the surgical team is finding a way to better control post-operative pain, because pain controls a significant role in the length of time the patients stay in the hospital, the level of patient satisfaction, the recovery period and the patient's return to normal life activities. Millions of patients in the world undergo surgery every year, and most of them report unrelieved pain after the surgery. Aim: To compare the control and reduction of acute pain in patients after laparoscopic gallbladder surgery by injectable acetaminophen and injectable ketamine. Materials and methods: this RCT study, which was conducted as a non-blind randomized clinical trial, 50 laparoscopic gallbladder surgery patients who referred to the teaching hospitals of Qazvin University of Medical Sciences in 2022 were selected as available and as Injectable acetaminophen and injectable ketamine were randomly divided into two drug groups and pain reduction was investigated and analyzed. Results: this study, the average age group of patients (in two groups) was 49.34 ± 13.52, and the pain reduction in both groups was less in those under 30 years of age, and more pain reduction in those over 30 years old, so that over 50 years of age had the greatest pain reduction, and The reduction of pain in the acetaminophen group was more than that of ketamine and it was statistically significant (P = 0.02). The reduction in pain intensity in the patients in the injectable acetaminophen drug group after receiving the full dose of the drug showed a noticeable and greater decrease compared to the ketamine group. Therefore, injectable acetaminophen was seen as an effective drug in reducing pain after laparoscopic surgery and it was statistically significant. (P = 0.002). Conclusion: In this study, the effect of injectable acetaminophen was very effective in reducing the amount of pain and the intensity of pain after laparoscopic surgery, but ketamine not only does not reduce the effect of pain, but it also changes the effect of other.

Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double-blinded Randomized Study.

Preemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA. This was a double-blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann-Whitney U test, respectively. Categorical variables were compared by the Pearson's chi-squared test. The control and acetaminophen groups were comparable in postoperative 0-24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications. In this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.

Efficacy of Oral Dextrose versus Acetaminophen versus Placebo on Pain Relief during Retinopathy of Prematurity Eye Examinations: A Randomized, Double-Blind Controlled Clinical Trial.

To assess the effect of oral dextrose versus acetaminophen versus placebo in pain relief in retinopathy of prematurity (ROP) examination. In this prospective randomized, double-blind controlled clinical trial study performed in the ophthalmology clinic of Shafa Hospital (referral hospital for eye disease), Kerman, Iran, 105 premature neonates with birth weight ≤2000 g and gestational age between 28 and 34 weeks were studied. Pain score measurement with Premature Infant Pain Profile-Revised (PIPP-R) during ROP examination in three intervention groups, acetaminophen group (15 mg/kg oral acetaminophen), dextrose group (one cc of oral dextrose 50%), and placebo group (one cc of distilled water), was done. Out of 105 infants, 33 infants received acetaminophen drops, 35 infants received dextrose drops, and 37 infants received placebo. The mean pain score of the group receiving acetaminophen was 11.39, dextrose 12.17, and placebo 11.54. The acetaminophen group had a lower average PIPP-R score. This difference was not significant between the three groups (P = 0.38). Acetaminophen and dextrose in comparison with distilled water did not show a significant difference in reducing neonatal pain during ROP examinations. However, the PIPP-R score in the acetaminophen group was lower compared to the other groups.