Routine use of intravenous acetaminophen safely enhances pain control after minimally invasive hepatectomies: a retrospective cohort study.

IF 1.8 3区医学 Q2 SURGERY

BMC Surgery Pub Date : 2025-10-03 DOI:10.1186/s12893-025-03169-0

Kei Furuya, Masao Nakajima, Yukio Tokumitsu, Yoshitaro Shindo, Hiroto Matsui, Yuta Kimura, Yuki Nakagami, Yusaku Watanabe, Shinobu Tomochika, Noriko Maeda, Michihisa Iida, Hidenori Takahashi, Tatsuya Ioka, Tomio Ueno, Hiroaki Nagano

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Abstract

Background: Effective postoperative pain management is crucial after minimally invasive hepatectomy (MIH) to promote recovery, and multimodal analgesia strategies are used to reduce opioid requirements and improve outcomes. Acetaminophen is commonly included as part of multimodal therapies for postoperative pain management. However, the safety and efficacy of acetaminophen for postoperative analgesia in MIH remains unestablished due to its hepatic metabolism. This study aimed to evaluate the safety and efficacy of routine intravenous acetaminophen administration following MIH.

Methods: The data of consecutive 50 patients who had undergone MIH were retrospectively analyzed. Regarding postoperative analgesia, patients were allocated to either the opioid-alone cohort (Cohort O) or opioid with routine intravenous acetaminophen cohort (Cohort A). Analgesic efficacy was evaluated using the numerical rating scale (NRS) over the first 2 postoperative days. The sum of opioid rescue doses and frequency of postoperative nausea and vomiting (PONV) were assessed. Analgesic safety was determined by monitoring prolonged elevated transaminase levels.

Results: Postoperatively, no significant differences in the hepatic and renal functions and systemic inflammatory markers were observed between the two cohorts. On both postoperative day 1 and day 2, Cohort A showed significantly lower NRS scores than Cohort O. Notably, almost all patients in Cohort A did not require any rescue opioid doses, resulting in a significantly reduced median rescue dose (6 versus 0 doses, p = 0.0017). Even when opioid doses were reduced due to PONV, Cohort A continued to exhibit significantly lower NRS scores.

Conclusions: Multimodal analgesia comprising routine intravenous acetaminophen administration could be safe and effective after minimally invasive hepatectomy, without adverse effects regarding hepatic function.

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常规使用静脉对乙酰氨基酚安全增强疼痛控制微创肝切除术后：回顾性队列研究。

背景：有效的术后疼痛管理是微创肝切除术（MIH）后促进康复的关键，多模式镇痛策略用于减少阿片类药物的需求并改善预后。对乙酰氨基酚通常作为术后疼痛管理的多模式治疗的一部分。然而，由于对乙酰氨基酚的肝脏代谢，对乙酰氨基酚用于MIH术后镇痛的安全性和有效性尚未确定。本研究旨在评价MIH后常规静脉给药对乙酰氨基酚的安全性和有效性。方法：对连续50例MIH患者的资料进行回顾性分析。在术后镇痛方面，患者被分配到单独使用阿片类药物的队列（队列O）或阿片类药物联合常规静脉注射对乙酰氨基酚的队列（队列A）。术后2天采用数值评定量表（NRS）评价镇痛效果。评估阿片类药物抢救剂量和术后恶心呕吐（PONV）发生频率。通过监测长期升高的转氨酶水平来确定镇痛安全性。结果：术后两组患者肝肾功能及全身炎症指标均无明显差异。在术后第1天和第2天，队列A的NRS评分均明显低于队列o。值得注意的是，队列A中几乎所有患者都不需要任何阿片类药物的救援剂量，导致中位救援剂量显著降低（6比0剂量，p = 0.0017）。即使当阿片类药物剂量因PONV而减少时，队列A继续表现出显著较低的NRS评分。结论：微创肝切除术后常规静脉给予对乙酰氨基酚的多模式镇痛是安全有效的，对肝功能无不良影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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