Comparison of Propacetamol plus Fentanyl and Fentanyl alone with Patient Controlled Analgesia after Total Knee Arthroplasty

OBJECTIVE: Opioid analgesics, for postoperative pain management, are an indispensable group of medication; however, they also have a variety of adverse drug reactions (ADR). Multimodal methods, combining non-opioid analgesics with opioid analgesics, have been investigated to increase the effects of analgesics and reduce ADR with opioid-sparing effects. The purpose of this study was to compare the effects of patient-controlled analgesia (PCA) with fentanyl alone, and PCA with fentanyl and intravenous (i.v.) propacetamol to determine the effects of pain control, cumulative opioid usage, and opioid ADR. METHODS: The subjects were patients who underwent total knee arthroplasty at the Seoul Veterans hospital from January 1, 2015 to December 31, 2016. The study period was from postoperative day 0 (POD0) to day 3 (POD3), and the retrospective study was conducted using electronic medical records. RESULTS: Pain severity was significantly low at POD1 (p = 0.017), POD2 (p = 0.003), and POD3 (p = 0.002) in the multimodal group. The fentanyl only group frequently reported both moderate and severe pain at a statistically significant level. This was consistent with the analysis of the pro re nata (PRN) intramuscular analgesia usage at the time of numerical rating scale (NRS) 4 and above. The opioid-sparing effect confirmed that the average opioid dose equivalent to i.v. morphine dose was 9.4 mg more than that used for the multimodal group in the fentanyl only group. The ADRs and length of stay between the two groups were not statistically different. CONCLUSION: The results of this study suggest that the combination therapy of fentanyl and i.v. propacetamol is superior to fentanyl monotherapy.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

Predictive Factor of Blood Pressure Lowering in Patients with Fever Using Propacetamol

PURPOSE: This study aimed to identify predictive factors for decreased blood pressure in patients prescribed with propacetamol in the emergency room using clinical and laboratory indicators of sepsis. METHODS: Among patients aged 18 years or older with a fever, who visited Chungbuk National University hospital's emergency room between July and December of 2014, 246 patients underwent intravenous infusion of propacetamol to control body temperature. Of these, 112 patients fulfilled all study requirements. Patients whose systolic or diastolic blood pressure dropped below 90 mmHg or 60 mmHg, respectively, were included in the blood pressure decline group. Additional inclusion criteria were a decline in systolic blood pressure of more than 30-mmHg and thereby treated with fluids or inotropics after intravenous infusion of propacetamol. Remaining patients were included in the blood pressure maintenance group. The relationship of each factor between the two groups was then investigated. RESULTS: Twenty-nine patients (25.9%) showed a significant decrease in blood pressure, and among many factors, high-sensitivity C-reactive protein (hs-CRP) (cut off value, 11.86; sensitivity, 72.4%; specificity, 69.9%; area under curve [AUC], 0.698) and procalcitonin (cut off value, 0.67; sensitivity, 75.9%; specificity, 60.2%; AUC, 0.667) levels showed a statistically significant effect. Of the 29 patients with a decrease in blood pressure, 10 patients received fluids and inotropics; procalcitonin in particular showed a significant effect. CONCLUSION: When propacetamol is administered to patients at the emergency room, and if hs-CRP or procalcitonin levels are high, there is an increased risk of a decrease in blood pressure. In particular, if procalcitonin levels are high, aggressive treatment is required, such as administration of inotropics in addition to fluids.

A Comparative Efficacy of Propacetamol and Ketorolac in Postoperative Patient Controlled Analgesia

BACKGROUND: Ketorolac has been used as a postoperative analgesia in combination with opioids. However, the use of ketorolac may produce serious side effects in vulnerable patients. Propacetamol is known to induce fewer side effects than ketorolac because it mainly affects the central nervous system. We compared the analgesic effects and patient satisfaction levels of each drug when combined with fentanyl patient-controlled analgesia (PCA). METHODS: The patients were divided into two groups, each with n = 46. The patients in each group were given 60 mg of ketorolac or 2 g of propacetamol (mixed with fentanyl) for 10 minutes. The patients were then given 180 mg of ketorolac or 8 g of propacetamol (mixed with fentanyl and ramosetron) through PCA. We assessed the visual analogue pain scale (VAS) at the time point immediately before administration (baseline) and at 15, 30, and 60 minutes, and 24 hours after administration. Also, the side effects of each regimen and each patient's degree of satisfaction were assessed. RESULTS: There was a significant decline in the VAS score in both groups (P < 0.05). However, there were no significant differences in the VAS scores between the groups at each time point. Satisfaction scores between the groups showed no significant difference. CONCLUSIONS: The efficacy of propacetamol is comparable to that of ketorolac in postoperative PCA with fentanyl.

The preemptive analgesic effect of ketorolac and propacetamol for adenotonsillectomy in pediatric patients / 대한마취과학회지

BACKGROUND: Both ketorolac and propacetamol are used postoperatively to control mild to moderate pain. This study compared the analgesic efficacy of ketorolac and propacetamol delivered either preoperatively or postoperatively, and assessed the preemptive analgesic effect of ketorolac and propacetamol for adenotonsillectomy. METHODS: One hundred and two pediatric patients were divided randomly into four groups. The K1 and P1 groups received ketorolac 1 mg/kg or propacetamol 30 mg/kg after induction, respectively, whereas the K2 and P2 groups received each drug at the end of the operation, respectively. After adenotonsillectomy, we measured the NRS (Numerical Rating Scale), FPS (Faces Pain Scale) and OPS (Objective Pain scale) at 15, 30 and 60 min after arriving at the postanesthesia care unit. RESULTS: There were no significant differences in the NRS, FPS and OPS between K1 and K2 and between P1 and P2 for 60 min after operation at the postanesthesia care unit. CONCLUSIONS: These results suggest that both ketorolac (1 mg/kg) and propacetamol (30 mg/kg) have no preemptive analgesic effects during 1 hour after adenotonsillectomy.

The effect of ketorolac and propacetamol on pain control after tonsillectomy in pediatric patients / 대한마취과학회지

BACKGROUND: Both ketorolac and propacetamol have been used to control mild to moderate pain after operation. Ketorolac is a non-steroid anti-inflammatory drug (NSAID) with strong analgesic activity, but should be avoided in patients with renal dysfunction or bleeding complications. Propacetamol is a prodrug of paracetamol and can be delivered intravenously. Importantly, it has fewer side effects and therefore generally considered safe. The purpose of this study is to compare the analgesic efficacy of ketorolac and propacetamol for pain control after tonsillectomy in pediatric patients. METHODS: The pediatric patients were randomly divided into three groups. All patients were given propofol and fentanyl for induction. During induction, one group received ketorolac 1 mg/kg (group K), another group received propacetamol 30 mg/kg (group P), and the other group received saline (group C). Postoperative pain was assessed by Visual Analogue Scale (VAS) and Faces Pain Scale (FPS) at 15, 30 and 60 min after arrival at the recovery room. RESULTS: VAS and FPS at 30 and 60 min after arrival were significantly lower in group K and P than in group C (P < 0.05). No adverse side effect was observed in all groups after tonsillectomy. CONCLUSIONS: Propacetamol can be used as a safe alternative to ketorolac for pain control after tonsillectomy in pediatric patients.

Does Pretreated NSAIDs Decrease the Postoperative Consumption of Morphine? / 대한마취과학회지

BACKGROUND: NSAIDs (Nonsteroidal antiinflammatory drugs) had been known as having analgesic property and its mechanism is prostaglandin synthesis blocking action -peripheral mechanism-. Nowadays, central mechanism of NSAIDs were postulated by some animal or clinical studies, but the preemptive analgesic effects have been still in controversy. Thus, authors planned this study to evaluate whether NSAIDs have the preemptive analgesic effect by using propacetamol and ketorolac. METHODS: Seventy five patients undergoing laparoscopic vaginal hysterectomy were subjected and randomly allocated into three groups according to drugs given. Group P (n=25) and group K (n=25) were given propacetamol 2 gm or ketorolac 30 mg intravenous respectively at 15 minutes before induction. Group C (n=25) had no medication. Pain control using morphine were started in all three groups before skin incision. One anesthesiologist who didn't know which group the patients were allocated visited the patients when the patient arrived at recovery room after operation, postoperative 1 hour, 6 hours, 12 hours, 24 hours and 48 hours and estimated pain score and side effects. Parameters using pain score were visual analogue score (VAS; 100 mm) -subjective parameter- and Prince-Henry score (PHS) -objective parameter-. If VAS>50 or PHS>3, morphine 2.5 mg were given by i.v. and pain score were reestimated after 5 minutes and same dose of morphine were given until VAS<50 and PHS<3. RESULTS: Demographic data of three groups were insignificant. In group P, lower VAS, PHS and morphine consumption were observed than the other groups. Significant changes according to time were observed until postoperative 6 hours in each groups. Side effects occurred as nausea, vomiting and somnolence but statistical significance between groups were absent. CONCLUSIONS: Preoperative i.v. administration of propacetamol 2 gm in laparoscopic vaginal hysterectomy could have preemptive analgesic effects. But we think that determining the proper dosage and timing of administration that could have preemptive analgesic effect of NSAIDs are subjects demands further study.

The Morphine-Sparing Effect of Propacetamol on Patient Controlled Analgesia in Gynecological Surgery / 대한산부인과학회잡지

BACKGROUND: The efficacy and safety of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient controlled analgesia(PCA) were studied in 40 patients after gynecological surgery requiring lower abdominal incision. METHODS: Using a double-blind, randomized, parallel-group design, the effects of four (every 6 hr) intravenous injections of 2 g propacetamol(=1 g acetaminophen) were compared with four injections of placebo in the recovery room immediately after surgery. Efficacy was assessed over 24hr by automated recording on the PCA device of the cumulative dose of morphine and the number of boluses requested. It was assessed on pain scores rated on a ten-point verbal scale, at 30 minutes, 1hr, 2hr, 4hr and then every 4hr until the 24hr after administration. Any side effects were recorded throughout the duration of the study, and the ability to tolerate the drug was assessed by recording of hemodynamic changes, patient satisfaction, the frequency of side effects and sedation scores at the predetermined time interval as above. RESULTS: The 24-hr morphine consumption was significantly decreased in the propacetamol group. Analysis of the hourly morphine doses showed a significant decrease from the fourth hour. Although there was no significant difference in pain scores between the two groups, 80% of patients in the morphine group versus 85% of the propacetamol group found it "good" or "extremely good". The incidence of nausea was less in the propacetamol group. The incidence of other side effects were statistically insignificant. CONCLUSION: Propacetamol has demonstrated a morphine sparing effects(=37%) in gynecological postoperative pain, thus confirming that it is a useful and safe injectable non-NSAID, nonopioid analgesic in postoperative period.