ABSTRACT
Introduction: There are many reports about hepatotoxicity associated with acute overdose or long-term use of acetaminophen, but few reports of that associated with therapeutic doses. We present a case of acute liver failure with hepatic coma caused by therapeutic doses of intravenous acetaminophen for cancer pain relief in palliative care setting. Case: The patient was a 56-year-old woman with stage IV lung cancer and normal liver function. She was admitted to the hospital because of anorexia and cancer pain. She received 1g intravenous acetaminophen every six hours for analgesia of pleural and rib metastasis. The patient’s AST/ALT levels were elevated at 3104/1212 IU/L, while she was receiving 11 doses of intravenous acetaminophen. She was treated with oral N-acetylcysteine, hemadsorption and plasma exchange therapy. Liver function returned to normal soon. Discussion: Therapeutic doses of intravenous acetaminophen is generally used in palliative care setting, and hepatic failure may occur due to glutathione depletion in patients with cancer anorexia. The potential hazard of rare but serious complications should always be kept in mind even with therapeutic doses.
ABSTRACT
Background: Pain management is a crucial component in the postoperative care of patient. Opioids, which have been the mainstay of postoperative pain control for some time, are being used less because of significant adverse effects. Recently Intravenous acetaminophen that is an analgesic and antipyretic drug is used for reducing postoperative pain. Our Objective in this study was to use intravenous acetaminophen as an analgesic and antipyretic drug with the least complications and more safe than intravenous opioids for comparison with the effects of intravenous morphine sulfate in patients with acute abdominal surgery referred to emergency department of Fatemi Hospital.Methods: 120 patients with acute abdomen will be assigned into the study by randomized allocation. Demographic data, pain severity in admission to the emergency department and 30 minutes after injection, vital signs in admission, side effects, and clinical findings will record questionnaires. The pain level, tenderness and the rebound tenderness of the patients will determine by the Visual Analog scale. The subjects will be divided into two groups A and B randomly. The intravenous acetaminophen (15 mg/kg/100cc normal saline in the form of intravenous infusion for 30 minutes) will be administered for group (A) and intravenous morphine sulphate (0.1 mg/kg Slow-acting intravenous injection for 1.5 to 2 minutes) will be administered for group (B). After 30, 60 and 90 minutes, the patient's pain is re-examined. Changes in the patient's pain, tenderness, rebound tenderness and side effects will documented in two groups and they will be compared. Finally, the collected data will be analyzed.Results: The mean age of patients in acetaminophen group was 58.24±8.06 years with a mean age of 27-26 years and in morphine group was 56.7±7.63 years with age range of 34-69 years. There was no significant relationship between age and effect of intravenous acetaminophen and venous morphine sulphate (p=0.16). The mean of pain before injection of intravenous acetaminophen group was 8.92±1.25 and the mean pain before injection of morphine group was 8.80±1.35. There was no significant difference between the mean pain before injection of patients in the intravenous staphylococci group and the morphine group (p=0.049). The mean pain after injection of intravenous acetaminophen group was 4.46±1.25 and the mean pain after injection of the morphine group was 2.56±1.71. The mean pain after injection was significantly higher in patients with intravenous acetaminophen than in the morphine group (p<0.001).Conclusion: Due to the effectiveness of morphine in relieving the pain of patients, it is recommended that doctors and associates use this painkiller to relieve pain in patients
ABSTRACT
Introduction: Post operative pain after surgery is a cause ofsignificant morbidity and patient dissatisfaction. In this studywe try to compare efficacy between 1 gram acetaminophenoral dose with 1 gram acetaminophen intravenous dose incontrolling post operative pain.Material and methods: This study is a prospective,randomized and comparative study conducted at NRI instituteof medical sciences, Visakhapatnam between Oct 2016 toOctober 2017. 90 patients belonging to ASA status I and IIof both genders, age group- 18 to 60 years and undergoingsurgeries under general anaesthesia lasting less than 2 hourswere enrolled for the study. 2 groups out of which Group Areceived 1gm oral paracetamol and Group B received 1gmintravenous paracetamol. The grous were compared postoperatively for pain scores at 30, 60, 90, 120, 150 minute aftersurgery using visual analogua scale(VAS)Results: The mean VAS scores were 2.78, 4.07, 5.81, 6.36, 6.5for Group A and 2.18, 3.5, 4.76, 6.04, 6.43 for Group B. Thuspain scores were consistently lesser in Group B than GroupA. Pain scores were significantly lower in Group B during thetime period 30 mins and 90 mins (p values 0.039 and 0.002respectively). The time of first rescue analgesia (i.e, Fentanyl)was compared in both the groups. Mean for time of demandfor analgesia was 88.67 mins and 102 mins in Group A andGroup B respectively. P value was 0.05 thus a significantlyearlier requirement of rescue analgesia in Group A.Conclusion: The rescue analgesic requirement wassignificantly lesser in intravenous acetaminophen group.Hence 1gm intravenous paracetamol is superior to oralformulation in controlling post operative pain
ABSTRACT
The purpose of this study is to provide effective pain management by administration of an analgesic that gives the patients maximum satisfaction. The goal was to evaluate and compare the analgesics efficacy of acetaminophen with butorphanol; to determine if there is an overall decrease in opioid consumption and opioid-related adverse effects; and detect any adverse effects of acetaminophen as post-operative analgesics. Methods: In this randomized parallel-group controlled trial, post-operative patients were given either 1 g intravenous (IV) acetaminophen or 2 g IV butorphanol as post-operative analgesics. The post‑operative pain was evaluated by pain intensity scales and was measured at rest and during a deep breath over 24 h. If the reading in the pain intensity scale was above 5 then rescue medicine injection. Tramadol 100 mg IV SOS was given in both the groups. Any adverse effects reported by the patients were recorded. Results: The butorphanol group achieved slightly better pain ratings in the first 2 h and acetaminophen group after 6 h post-operatively. The overall visual analogue scale score across time was significantly lower for acetaminophen group than the butorphanol group (p = 0.02). The secondary outcome measure, rescue analgesic consumption (injection tramadol) was comparable between the two groups. Side-effects were less in acetaminophen than butorphanol, predominantly headache and sedation which was seen in butorphanol but was absent in acetaminophen. Conclusion: IV acetaminophen is an effective analgesic in obstetric and gynaecological surgeries with a good safety profile. When used in combination with opioids, they reduce opioid consumption, and this reduction is sufficient to reduce opioid-induced adverse effects.