Tuesday, August 2, 2011

Morphine sparing effect By Paracetamol

Acetaminophen or that we are familiar with Paracetamol is an analgesic antipyretic drug that is used to relieve pain and reduce fever. As an analgesic, paracetamol works by increasing the excitatory threshold of pain and as an antipyretic, suspected of working directly on the heat regulating center in the hypothalamus. Based on the guidelines of the WHO analgesic administration, in this case paracetamol, can be used on mild pain or moderate to severe pain when combined with opioid analgesics. Use of paracetamol in conjunction with opioid class of analgesics (morphine) can not only improve the effectiveness of analgesics but also can decrease the need for analgesic opioids (morphine) in moderate to severe pain, known by the name of the morphine sparing effect. Decline in demand is expected to decrease opioid side effects from the use of opioid analgesics group.

Meta-analysis by Remy et al (2005) conducted on seven prospective randomized studies with comparison, the number of patients with post-operative 265 in group acetaminophen (oral or intravenous) + morphine and 226 patients with morphine alone, showed that administration of acetaminophen reduces the need morphine (morphine sparing effect) by 20% (Average -9 mg; CI -15 to -3 mg, p <0.003). However, the results of this meta-analysis found no reduction in incidence of side effects of morphine morphine although demand has decreased.

In contrast to the results of a meta-analysis has been performed by Remy et al, the study by Young et al. (2011) of 76 women who underwent hysterectomy were randomly get 2 grams of intravenous premedication
of acetaminophen or placebo 30 minutes before surgery, suggesting that the need for morphine is 30% lower in the acetaminophen group and the side effects of nausea and vomiting are also found to be lower in the acetaminophen group.

As a conclusion, giving paracetamol to reduce the need for opioid analgesics (morphine), or known as the morphine sparing effect, and (according to some studies) may decrease side effects of morphine.

Article adopted from www.straightfromthedoc.com


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