Use Of Intravenous Paracetamol Research Articles

The impact of clinical pharmacists’ intervention on the rational use of intravenous paracetamol vials in Baghdad Teaching Hospital: A case-control study

Paracetamol has been recognized worldwide as a safe and effective agent for relieving pain and reducing fever in many patients. This study aimed to investigate the role of clinical pharmacist interventions in the rational and appropriate use of intravenous paracetamol in surgical patients and the impact of this rational use on hospital costs. A case-control study was conducted on 794 patients (400 in the intervention group and 394 in the control group). The appropriate and rational use of the drug was compared between baseline and post-intervention in the intervention group and between the two groups. The result showed a significant reduction in dispensed IV paracetamol vials after the pharmaceutical intervention (4,151 vials recovered by the intervention), which led to a reduction in the cost (8,302 USD reduction in the total cost). There was a significant reduction in the dose of IV paracetamol, use with or without adjunctive opioid analgesics, frequency of administration, duration of intravenous paracetamol use, daily max exceeding 4 g, and concomitant use with oral paracetamol after applying the clinical pharmacist intervention. In conclusion, the clinical pharmacist plays a vital role in various aspects of healthcare; clinical pharmacist involvement positively impacts the patient’s management plan by improving the optimal and rational use of intravenous paracetamol and decreasing hospital costs.

Single-centre, randomized, clinical trial of opioid-free analgesia versus routine opioid-based analgesia regimen for the management of acute post-operative pain following caesarean section: study protocol

<p class="abstract"><strong>Background: </strong>Pain management post-caesarean section is a common source of exposure to opioids in women. To address the rising opioid addiction associated with peri-operative administration, trend in operative analgesia is moving towards opioid-free, multimodal analgesia. We present our protocol for this study so that it may be replicated in other settings and possibly modified for future studies.</p><p class="abstract"><strong>Methods: </strong>In a Single-centre, non-inferiority, parallel, randomized, controlled, clinical trial with balanced allocation [1:1] into two arms, we compared a peri-operative opioid-free analgesia regimen with a routine post-operative opioid-based analgesia regimen in women undergoing caesarean section under spinal anaesthesia. Primary outcome measures were post-operative pain intensity at 4, 8 and 24 hours (using Numerical Rating Scale) and post-operative pentazocine use. Secondary outcome measures were the incidence of adverse events and Apgar score. Results will be published in a peer-reviewed, open access journal.</p><p class="abstract"><strong>Conclusions:</strong> This protocol adopted the use of intravenous paracetamol and intravenous NSAID as baseline analgesics. Magnesium sulphate was introduced peri-operatively as part of our opioid-free multimodal analgesia regimen because of its established effect in decreasing post-operative pain and opioid use. We also relied on the preventive analgesic effect of administration of intravenous paracetamol and intravenous magnesium sulphate before surgical incision, continued intraoperatively and post-operatively. In addition, magnesium sulphate is a familiar drug to the obstetrician, readily available and affordable in most settings where comprehensive emergency obstetric care is offered, easy to administer and it has been well tolerated clinically.</p><p class="abstract"><strong>Trial registration:</strong> This protocol was registered with clinicaltrials.gov (Identifier: NCT04539249) on September 3, 2020, prospectively.</p>

Use of Intravenous Paracetamol Preoperatively Favors Lower Risk of Delirium and Functional Recovery in Elderly Patients with Hip Fracture: A Propensity Score-Matched Analysis.

We aimed to investigate whether the use of intravenous paracetamol (IVP) preoperatively in intertrochanteric fracture (IF) patients aged 65 years or over receiving intramedullary fixation had significantly benefits on the pain score at discharge, delirium incidence, length of hospital stay (LOS), functional outcomes, and mortality. A retrospective analysis of all surgically treated patients presenting with IF was conducted at a single Level I trauma center in China between Jan. 2016 and Jan. 2020. The data concerning patients' demographics, injury-related data, surgery-related data, operation-related data, in-hospital data, and postoperative outcomes were extracted. To minimize potential confounding and selection bias, the propensity score matching (PSM) method was performed via the caliper matching method by using a 1 : 1 ratio. After PSM, McNemar's chi-square tests were used to examine the association of using IVP with outcome analyses. The Spearman correlations of IVP using, pain scores, and the factors which may influence them were also computed. After screening 2963 consecutive patients, 2166 were included finally, including 1576 in the non-IVP group and 590 in the IVP group. After PSM, 531 remained in each group. The pain scores at discharge were significantly between the two groups before and after matching (all p < 0.001). The differences of delirium rate and functional outcomes became significant after propensity score-based matching (p=0.001 and 0.033, respectively), although they were not significant before matching. No significant difference was observed in other operation-related data, LOS, and crude mortality rates at 30-day, 90-day, and 12-month before and after PSM. In conclusion, this study highlights the need for preoperative IVP use to optimize pain control, postoperative functional recovery, and minimize pain-related comorbidities such as delirium in elderly patients with hip fracture.

Efficacy of Preemptive Analgesia on Postoperative Pain Control in Children Who Underwent Full-Mouth Dental Rehabilitation Under General Anesthesia: A Randomized Controlled Clinical Trial.

To evaluate the efficacy of intravenous preemptive analgesia on postoperative pain in children undergoing dental rehabilitation under general anesthesia. In this prospective randomized clinical trial, 70 children aged 3 to 7 years were scheduled for dental treatment and randomized into two groups: the control group or the preemptive group. Patients received 15 mg/kg of intravenous paracetamol either before the start of treatment (preemptive group, n = 35) or at the end of treatment (control group, n = 35). Postoperative pain scores were recorded at 1, 2, 4, 6, 8, 12, and 24 hours using the Wong-Baker FACES Pain Rating Scale (WBFS). Additionally, the need for rescue analgesic and the total opioid consumption of the patients were recorded during the first 24 hours postoperative. The pain scores in the preemptive group were significantly lower than those in the control group at the postanesthesia care unit and at 2, 4, and 8 hours postoperative (P < .05). However, there were no statistically significant differences in pain scores between groups at 12 and 24 hours postoperative. Need for rescue analgesics and total intravenous fentanyl consumption were significantly higher in the control group than in the preemptive group (P < .05). The percentage of children who received medication for pain relief at home was higher in the control group than in the preemptive group, but the difference was not statistically significant (P > .05). Preemptive use of intravenous paracetamol reduces postoperative pain scores and postoperative opioid consumption. However, there is a need to evaluate pain levels in children who receive comprehensive dental treatment under general anesthesia after hospital discharge for effective postoperative pain control.

Use of intravenous paracetamol for patent ductus arteriosus closure in preterm and very low birth infants

The patent ductus arteriosus contributes to common morbidities in premature infants.Ductal closure may require pharmocological management and/or surgical ligation up to 70% of time in extremely low birth infants. Ductal closure utilising NSAIDs has many adverse effects related to their vasoconstrictive effects on renal cerebral and mesentric vessels. While NSAIDS are known to inhibit COX activity via Arachidonic acid pathway, acetaminophen inhibits peroxidase activity. It seems to be a reasonable optionto consider for PDA closure, especially in those infants for which NSAIDSmay be contraindicated. Place of study: A prospective study in Neonatal intensive care unit 1. Maternity and childrens hospital. Makkah. Patients: preterms and extreme preterms-24–30 weeks, Birth weight 450 g-1.2 Kg with haemodynamically significant PDA. iNTERVENTION: iv PARACETAMOL −15 MG/kG/dose Q 6 hrly × 3–5 days with parenteal consent. 1. Total no: of admissions in NICU-1 1150. For 20 months from 8/1437 to 3/39. 2. 100 patients had haemodynamically significant PDA where NSAIDs were contraindicated. 3 24-26 wks 20 27–29 wks 50 30–32 wks 30 4. weight wise distribution. <1 kg 1–1.5 Kg 1.5–2 kg. 45 52 3 5 male: female. M 53 F 47 1. −32% had PNA. 2–13% had CPR at birth. 3 −40% had IVH of which 11% had gradeIII-iv IVH. 4. −35% had pulmonary haemorrhage. 5 −13% had pneumothorax. 6. −61% had CLD. 7. −86% had hypotension 8. – 100% were NPO. 9. All had central line. 10. 90% had renal impairment. 11–95% had electrolyte imbalance either before or after treatment. 12 49% had +ve blood culture. 13. thrombocytopenia was noticed in 50% of them. 14 80% were discharged home 20% expired. PDA: echo first done: 1–7 days. 80% 2nd/3rd day. Duration of paracetamol: 3–5 days. Effective closure after 1st dose-44%. Effective closure after 2nd course of paracetamol-21%. NSAIDS used after paracetamol in 10%. Hydrochlorthiazide used in 8%. PDA reopened due to sepsis-7%. Intravenous paracetamol can be safely used in extreme low birth infants.

Use of intravenous paracetamol compared with use of oral paracetamol for pain reduction

Use of intravenous paracetamol compared with use of oral paracetamol for pain reduction

Intravenous paracetamol — waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex—Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommen...

Intravenous paracetamol was associated with closure of the ductus arteriosus in extremely premature infants.

Symptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birthweight infants and is often resistant to medication. We evaluated early intravenous paracetamol for pain prevention during respiratory therapy, in an attempt to understand the ductal treatment of such infants. Our cohort were 295 extremely preterm or extremely low birthweight infants, born at less than 28weeks or 1000g, respectively, who were treated in the neonatal intensive care unit of Oulu University Hospital from 2002 to 2015, before and after intravenous paracetamol was introduced in June 2009. Ductal closure dates, paracetamol medication details, morbidities and mortality data were evaluated. Intravenous paracetamol was given to 128 infants, starting at a median of 4.4hours age (range: 0-169hours), with a mean total dosage of 212mg/kg (range: 7.5-1175mg/kg). We also included 167 controls who were mainly treated before we used intravenous paracetamol. Ibuprofen (p<0.001) and ligation (p=0.002) were lower in the paracetamol group than controls. No adverse effects were detected. Paracetamol was not associated with other morbidities. We found that early use of intravenous paracetamol decreased the incidence of ductal therapies in extremely premature or extremely low birthweight infants.

Randomized, controlled, multicentre clinical trial of the antipyretic effect of intravenous paracetamol in patients admitted to hospital with infection.

AimNo randomized study has been conducted to investigate the use of intravenous paracetamol (acetaminophen, APAP) for the management of fever due to infection. The present study evaluated a new ready‐made infusion of paracetamol.MethodsEighty patients with a body temperature onset ≥38.5°C in the previous 24 h due to infection were randomized to a single administration of placebo (n = 39) or 1 g paracetamol (n = 41), and their temperature was recorded at standard intervals. Rescue medication with 1 g paracetamol was allowed. Serum samples were collected for the measurement of APAP and its metabolites. The primary endpoint was defervescence, defined as a core temperature ≤37.1°C.ResultsDuring the first 6 h, defervescence was achieved in 15 (38.5%) patients treated with placebo compared with 33 (80.5%) patients treated with paracetamol 1 g (P < 0.0001). The median time to defervescence with paracetamol 1 g was 3 h. Rescue medication was given to 15 (38.5%) and five (12.2%) patients allocated to placebo and paracetamol, respectively (P = 0.007); nine (60.0%) and two (40.0%) of these patients, respectively, experienced defervescence. No further antipyretic medication was needed for patients becoming afebrile with rescue medication. Serum glucuronide‐APAP concentrations were significantly greater in the serum of patients who did not experience defervescence with paracetamol. The efficacy of paracetamol was not affected by serum creatinine. No drug‐related adverse events were reported.ConclusionsThe 1 g paracetamol formulation has a rapid and sustainable antipyretic effect on fever due to infection. Its efficacy is dependent on hepatic metabolism.

Postoperative analgesia after laparoscopic cholecystectomy by preemptive use of intravenous paracetamol or ketorolac: A comparative study

Background: Laparoscopic cholecystectomy is associated with postoperative pain due operative ports site and residual intraperitoneal gas CO 2 . Preemptive analgesia is one of the promising strategies of postoperative pain relief. The present study is undertaken to compare the efficacy of preemptive intravenous paracetamol versus ketorolac for post operative analgesia after laparoscopic cholecystectomy. Method: Ninety adult consented patients 18-58 yr of age, of either sex, of ASA grade I/II were randomized into two equal groups of 45 patients each. Patients of group I received infusion of paracetamol 1 g and group II received infusion of ketorolac 30 mg, 30 minutes before the induction of general anaesthesia. Postoperative pain was evaluated by standard 10 cm linear visual analogue scale at different time intervals. When VAS was more than 3 rescue analgesic 50 mg tramadol intravenously stat was given. Intraoperative hemodynamic and any side effects were also recorded for statistical analysis. Results: Demographic profile and hemodynamic parameters i.e intraoperative heart rate and mean arterial blood pressure were comparable in both the groups. Post operative VAS scores were persistently higher in paracetamol group with statistically significant difference (P value < 0.05). All 45 patients in paracetamol group and 8 patients in ketorolac group required rescue analgesic within 6 hrs of study time. Total tramadol consumption was much higher (2250 mg) in paracetamol group as compared to 400 mg in ketorolac group. Conclusion: Preemptive use of ketorolac exerted superior postoperative analgesia after laparoscopic cholecystectomy in comparison to paracetamol without any significant side effect.

Prophylactic intravenous paracetamol for prevention of shivering after general anesthesia in elective cesarean section

Background: Postoperative shivering is an important common complication after general anesthesia. This may lead to dissatisfaction and a sense of discomfort, especially in parturients undergoing cesarean section. In addition to warming, many drugs have been investigated for prevention of shivering. The aim of this study was to evaluate the efficacy of intravenous paracetamol for prevention of shivering after general anesthesia in cesarean section. Materials and Methods: In this prospective randomized double-blind controlled clinical trial, 110 pregnant women, physical Status I or II, based on the classification of American Society of Anesthesiologists (ASA), aged 18–40 years, who were scheduled for elective cesarean section under general anesthesia were included in the study. They were randomly divided into two groups of 55 each. One group received 100 ml normal saline, and another group received 1 g of paracetamol in 100 ml normal saline intravenously, 15 min after the delivery of the baby. The anesthesia technique was similar in both the groups. Tympanic membrane temperature was measured before and after the induction of anesthesia and every 15 min till the end of recovery from anesthesia. Postanesthetic shivering was graded on a scale of 0 to 4; if the score was more than 2, it was treated with 25 mg pethedine. Vital signs and side effects were recorded during the surgery and recovery period. Results: There were no significant differences between the two groups regarding age, weight, height, and duration of surgery (P > 0.05). Shivering was seen in 5 parturients (9.1%) in paracetamol group (group A) and 28 parturients (50.9%) in the saline group (group N). On a scale of 0 to 4, shivering was of lower intensity in paracetamol group compared to the saline group (P 0.05). There was no difference in the incidence of hypotension, nausea, and vomiting among the two groups (P > 0.05). Conclusion: The prophylactic use of intravenous paracetamol during surgery is effective for the prevention of postoperative shivering.

The Effect of Intravenous Paracetamol on Postoperative Pain after Lumbar Discectomy

Study DesignA randomized, double-blinded controlled trial.PurposePostoperative pain relief especially using analgesic drugs with minimal side effects has considerable clinical importance. This study aimed to examine the effect of intravenous paracetamol on pain relief after lumbar discectomy as a major surgery.Overview of LiteraturePatients undergoing lumbar discectomy experience a high degree of lumbar pain. Some authors emphasize the use of intravenous paracetamol to improve postoperative pain and increase patients' satisfaction following this surgery.MethodsFifty-two patients scheduled for lumbar discectomy were randomly allocated into two groups: a group that received intravenous paracetamol (1 g/100 mL normal saline) within the last 20 minutes of surgery as the case group (n=24) and a group that received sodium chloride 0.9% 100 mL as the control group (n=28). Postoperative pain was assessed at 1, 6, 12, 18, and 24 hours after surgery by a visual analogue scale (VAS). The dosage of the administered opioid (morphine), as well as drug-related side effects within the first 24 hours after surgery were also recorded.ResultsThe mean VAS score was significantly lower in the paracetamol group than the controls for all of the assessed time points. Although the dose of the administered morphine was numerically lower in the paracetamol group, this difference was not statistically significant (5.53±4.49 mL vs. 7.85±4.17 mL).ConclusionsIntravenous paracetamol as a non-opioid analgesic can relieve postoperative pain in patients undergoing lumbar discectomy; however, its use alone may not represent the best regimen for reducing the needed dose of opioids after operation.

Perioperative Pain Management in Orthopedic Surgery

Perioperative pain management should now be an integral part of all inpatient and outpatient orthopedic surgical procedures. In addition to planning the surgical approach, equipment, and implants needed for a successful surgical outcome, the orthopedic surgeon should also be involved with and help plan the perioperative pain management strategies. Patient outcome and satisfaction data, especially pain relief after surgical procedures, will soon be required to be reported to the Centers for Medicare and Medicaid Services (CMS) using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores,1 and lower scores may eventually negatively affect hospital reimbursement. This special supplement to ORTHOPEDICS is focused on newer aspects of perioperative pain management. Multimodal pain protocols are now considered “state of the art” for all surgical procedures. The fi rst article reviews the general concepts of multimodal pain management, with a major goal being the reduction in the amount of opioid medications required for the postoperative orthopedic patient. This goal should be carefully considered, as The Joint Commission recently issued a Sentinel Event Alert on the safe use of opioids to reduce adverse events in hospital settings.2 The alert included suggestions for actions regarding hospital processes, technology, education, and standardized tools that can be used to screen patients for risk factors associated with oversedation and respiratory depression. This alert also recommended the use of modalities, nonopioid medication, and nerve blocks to decrease the incidence of opioid-related adverse reactions. The second article of this supplement introduces the use of intravenous acetaminophen for perioperative pain protocols for a wide variety of orthopedic procedures. Although this medication has been routinely used for almost 10 years in Great Britain, it has only been available for use in the United States since January 2011. Many orthopedic surgeons may not be familiar with the mechanism of action and the unique pharmacokinetics of this medication when given intravenously. There are major differences in serum and cerebrospinal fl uid levels when this medication is given orally and intravenously. The third article, from Great Britain, is a prospective cohort study of the use of intravenous paracetamol (acetaminophen) preoperatively in a group of elderly patients with hip fractures. These elderly patients with multiple comorbidities seem to be an ideal group to be given nonopioid medications both preand postoperatively. The fourth article is a retrospective cohort study of one hospital’s multimodal pain management protocol in total hip and knee arthroplasty patients, specifi cally looking at the preoperative use of two intravenous medications to decrease the amount of opioid medication used postoperatively. Pain management seems particularly crucial after total knee arthroplasty, because late residual unexplained pain may be related to less than optimal postoperative pain management. Obviously, there are many multimodal pain strategies that may be employed for these patients. The fi nal paper describes one hospital’s postoperative multimodal pain protocol following adolescent scoliosis surgery, in which rapid recovery of gastrointestinal function and avoidance of ileus is important for rapid overall recovery. The orthopedic surgical team should consider a reevaluation of their present pain management protocols to increase patient satisfaction and decrease the amount of opioid medication given perioperatively.

IV paracetamol vs other opiates and analgesics

IntroductionA trial of the use of intravenous Paracetamol in high dependency labouring women at JCUH was undertaken to assess the need for additional pain relief and delivery and neonatal outcome.MethodsWomen...

Single-centre audit on the use of intravenous paracetamol in neonates

An intravenous formulation of paracetamol is available, but remains off-label in patients below 10 kg although pharmacokinetics during repeated intravenous administration were documented and dosing regimes suggested [1,2]. We therefore retrospectively evaluated aspects of the administration of intravenous paracetamol in neonates.