medigraphic.com

2013, Number 1

<< Back Next >>

Rev Mex Anest 2013; 36 (1)

The perioperative acute pain and paracetamol: A view based in the evidence

Covarrubias-Gómez A, González-García JL, Betancourt-Sandoval JA, Mendoza-Reyes JJ

Language: Spanish
References: 42
Page: 47-55
PDF size: 151.91 Kb.


ABSTRACT

Settings: Surgical procedures in Mexico are frequent. It is possible that during the next five years the number procedures will increase a 20%. It has been reported that 80% of surgical patients will present pain and 80% of those in pain will report a moderate to severe intensity. National and International evidence-based guidelines for the management of perioperative pain had been published and are accessible however the recommended approach for pain management in surgical patients is neuraxial epidural continuous analgesia with a combination of local anesthetics and opioids. In some patients this approach is not possible due multiple causes. Objective: To fundament in the available evidence the use of paracetamol in the management of perioperative pain as an integrative structured analgesic approach. Materials and methods: Review of available evidence. Results: Despite the controversies related to the mechanism of action of paracetamol it has been proposed that this drug have a predominant effect in systems that are independent (but somehow related) to COX activity. Its analgesic effect when compared to placebo is statistically significant and its «spare opiod effect» decreases opioid consumption in 50%. The combination of paracetamol and NASAID decreases significantly the opioid consumption and promote a better analgesia. Conclusion: We propose that the analgesic approach for a surgical patient must consider opioids in combination with paracetamol and NASAID. This scheme must consider the specific conditions of each individual. It is necessary to generate new lines of investigation in order to generate more evidence.


REFERENCES

  1. Valdespino JL, Olaiz G, López-Barajas MP, Mendoza L, Palma O, Velázquez O, Tapia R, Sepúlveda J. Encuesta Nacional de Salud 2000. Tomo I. Vivienda, población y utilización de servicios de salud. Cuernavaca, Morelos, México. Instituto Nacional de Salud Pública, 2003.

  2. Merrill C, Elixhauser A. Procedures in U.S. Hospitals, 2003. Rockville, MD. Agency for healthcare research and quality; 2005. HCUP Fact Book No. 7. AHRQ Publication No. 06-0039.

  3. Canadian Institute for Health Information. Trends in acute inpatient hospitalizations and day surgery visits in Canada, 1995-1996 to 2005-2006 [fecha de consulta: 15 de noviembre, 2007.]. Disponible en Internet: www.cihi.ca

  4. Sistema Nacional de Información en Salud (SINAIS). [Consultada: 15 de Noviembre, 2010]. Disponible en Internet: http://sinais.salud.gob.mx

  5. Donovan M, Dillon P, McGuire L. Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain 1987;30:69-87.

  6. Hutchison RW. Challenges in acute post-operative pain management. Am J Health Syst Pharm 2007;64:S2-S5.

  7. Guevara-López U, Covarrubias-Gómez A, Hernández Ortiz A. Grupo de consenso para el desarrollo de los parámetros de práctica para el manejo del dolor agudo. Desarrollo de los parámetros de práctica para el manejo del dolor agudo. Rev Mex Anest 2004;27:200-204.

  8. Guevara-López U, Covarrubias-Gómez A, Rodríguez-Cabrera R, Carrasco-Rojas A, Aragón G, Ayón-Villanueva H. Parámetros de práctica para el manejo del dolor en México. Cir Cir 2007;75:385-407.

  9. Leininger SM. Managing pain in the older adult patient: pain management in the ED. Topics Emerg Med 2002;24:10-18.

  10. Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiology Clin N Am 2005;23:21-36.

  11. Guevara-López U, Covarrubias-Gómez A, Delille-Fuentes R, Hernández-Ortiz A, Carrillo-Esper R, Moyao-García D. Parámetros de práctica para el manejo del dolor agudo perioperatorio. Cir Cir 2005;73:223-232.

  12. American Society of Anesthesiologists Task Force for Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology 2004;100:1573-1581.

  13. National Health and Medical Research Council. Acute Pain Management: Scientific Evidence. NHMRC, Canberra. Australia; 1999.

  14. Covarrubias-Gómez A. dolor postoperatorio. Carrillo-Esper R, ed. En: Tópicos selectos en anestesiología. Distrito Federal, México; 2008: 291-302.

  15. Charlton E. The Management of Postoperative Pain. Update in Anesthesiology [fecha de consulta: 4 de febrero de 2009] 1997;7:2-17. Disponible en Internet: www.anaesthesiologists.org

  16. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 2001;93:853-858.

  17. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002;89:409-423.

  18. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 2003;290:2455-2463.

  19. Wu CL, Cohen SR, Richman JM, Rowlingson AJ, Courpas GE, Cheung K, Lin EE, Liu SS. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology 2005;103:1079-1088.

  20. Goodman AG. Las bases farmacológicas de la terapéutica. Sexta edición. México; 2000.

  21. Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: new vistas of an old drug. CNS Drug Rev 2006;12:250-275.

  22. Ottani A, Leone S, Sandrini M. The analgesic activity of paracetamol is prevented by the blockade of cannabinoid CB1 receptors. Eur J Pharmacol 2006;531:280-281.

  23. Sandrini M, Romualdi P, Vitale G. The effect of a paracetamol and morphine combination on dynorphin A levels in the rat brain. Biochem Pharmacol 2001;61:1409-1416.

  24. Whelton A. Appropriate analgesia: an evidence-based evaluation of the role of acetaminophen in pain management. Am J Ther 2005;12:43-45.

  25. Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev 2008;4:CD004602.

  26. Christo PJ. Opioid effectiveness and side effects in chronic pain. Anesthesiol Clin North America 2003;21:699-713.

  27. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSADs, or their combination in postoperative pain management: A qualitative review. Br J Anesth 2002;88:199-214.

  28. Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: A qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010;110:1170-1179.

  29. McCrory CR, Lindhal SGE. Cyclooxygenase inhibition for postoperative analgesia. Anesth Analg 2002;95:169-176.

  30. Olaiz-Fernández G, Rivera-Dommarco J, Shamah-Levy T, Rojas R, Villalpando-Hernández S, Hernández-Ávila M, Sepúlveda-Amor J. Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Publica, 2006.

  31. García-Rodríguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual nonsteroidal anti-inflammatory drugs. Lancet 1994;343:769-772.

  32. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal antiinflammatory drugs. An update for clinicians: a scientific statement from the American Heart Association. Circulation 2007;115;1634-1642.

  33. Gooch K, Culleton BF, Manns BJ, Zhang J, Alfonso H, Tonelli M, Frank C, Klarenbach S, Hemmelgarn BR. NSAID use and progression of chronic kidney disease. Am J Med 2007;120:280.e1-7.

  34. Mazer M, Perrone J. Acetaminophen-induced nephrotoxicity: pathophysiology, clinical manifestations, and management. J Med Toxicol 2008;4:2-6.

  35. Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: new vistas of an old drug. CNS Drug Rev 2006;12: 250-275.

  36. Schafer A. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol 1995;35: 209-219.

  37. Dart RC, Bailey E. Does therapeutic use of acetaminophen cause acute liver failure? Pharmacotherapy 2007;27:1219-1230.

  38. Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, Cobaugh DJ, Youniss J, Omslaer JC, May ME, Woolf AD, Benson BE. 2001 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2002;20:391-452.

  39. Duggan T, Scott L. Intravenous paracetamol (acetaminophen). Drugs 2009;69:101-113.

  40. García RLA, Pérez GS, Walker AM, et al. The role of non-steroidal antiinflammatory drugs in acute liver injury. BMJ 1992;305:865-868.

  41. Garcia RLA, Williams R, Derby LE, et al. Acute liver injury associated with nonsteroidal antiinflammatory drugs and the role of risk factors. Arch Intern Med 1994;154:311-316.

  42. Hernández-Díaz S, García-Rodríguez LA. Epidemiologic assessment of the safety of conventional nonsteroidal anti-inflammatory drugs. Am J Med 2001;110:S20-S27.




2020     |     www.medigraphic.com