title

استامینوفن: گاهی چیزهای قدیمی عامل جدید می شوند

محمدیان اردی, علی (1389) استامینوفن: گاهی چیزهای قدیمی عامل جدید می شوند. در: The First International Congress of Regional Anesthesia and Pain Interventions, September 15- 17 , 2010, Olympic Hotel, Tehran , iran.

[img]
پیش نمایش
متنی - نسخه چاپ شده
921kB
[img]
پیش نمایش
متنی - نسخه چاپ شده
1MB
[img]
پیش نمایش
متنی - نسخه چاپ شده
1MB

عنوان انگليسي

ACETAMINOPHEN: SOMETIMES OLD THINGS BECOME NEW AGAIN

خلاصه انگلیسی

Acetaminophen isn’t NSAID but is an effective analgesic and antipyretic, and has little or no anti-inflammatory and no antiplatelate activity. The mechanism of action hasn’t been fully understood, but it is now accepted that acetaminophen has effects on the periphery, spinal cord and brain levels. 1- In the periphery acetaminophen metabolism by proxidase produces reactive compounds that inhibit brady kinin-generated impulses within nociceptive fibers. 2- At the spinal cord level acetaminophen has been shown to antagonize neurotransmission via NMDA. substance-p and nitric oxide pathway. 3- In animal models, acetaminophen has been demonstrated to weakly inhibit COX-III in the brain. It has been hypothesized that subsequent reduction in PG production may result in an increase in the activity of descending serotonergic pathways, so modulating nociceptive inputs. Acetaminophen is a well-tolerated drug with few side effects in all age groups. Unlike nonsteroidal agents it is safe in pregnancy and children, down to neonatal ages. At recommended doses it is not associated with the increased incidence of nausea, vomiting, respiratory depression, ileus and other side effects as seen with opioids or the serious gastrointestinal, hematological, renal and cardiovascular side effects associated with NSAIDs including the COX-II inhibitors. Acetaminophen has been shown to have an efficacy equal to aspirin on a dose-per-dose basis and no propensity to be addictive, even in frequent applications. Hepatotoxicity is relatively rare, but acetaminophen has been found to have a narrow therapeutic window. Acetaminophen has analgesic effects in acute and chronic conditions and cancer pain. 49 The First International Congress of Regional Anesthesia and Pain Interventions and 3rd Annual Congress of ISRAPM ايلیه کىگر بیه المللی رژی وًال آوستزی ي ایىتريوشىال درد ي س مًیه کىگر سالیاو اوجمه رژی وًال آوستزی ي درد ایران In chronic pain management acetaminophen is required up to 4gr/day in divided doses for at least seven days. Acetaminophen is available in combination with several opioids and NSAIDS. The fixed combination of ASA, paracetamol and caffeine was superior to the other combinations in pain control. WHO has recommended acetaminophen to be used as the first line medication for mild, moderate or severe pain and addition of opioids and other analgesics if the pain remains persistent or exacerbates. Acetaminophen is available in oral, rectal and intravenous formulations. Intravenous (IV) Acetaminophen in Post-surgical Pain: IV Paracetamol is used perioperativly as either sole agent for minor surgeries or adjunct analgesia for major surgeries. Injectable acetaminophen derivatives offer advantages over opioids as they are associated with a little to no risk of nausea, vomiting, sedation, ileus, or respiratory depression. They also offer advantages over ketorolac in that there is little to no risk of platelet inhibition, GI ulceration, GI bleeding, renal toxicity. Acetaminophen can be comfortably used in all patients with NPO situations specially in post-surgical periods. In clinical trials the analgesic efficacy of IV acetaminophen was found to be equivalent to an earlier developed injectable acetaminophen preparation (IV propacetamole) and IV ketorolac (30 mg) . Propacetamole is an acetaminophen prodrug that is supplied as powder to be dissolved in saline or glucose solution and 2gr dose of it is equivalent to 1gr IV acetaminophen ( paracetamole). It is found that in patients with oral surgery 2gr of IV propacetamole followed by 1gr dose has a significant analgesic effect that is indistinguishable from the analgesia that is provided by 10mg IM dose of morphine. Unfortunately IV propacetamole is associated with pain (at the intravenous injection site or along the vein where its infusion is taking place) and contact dermatitis in health care professionals handling the drug. Therefore, this drug was withdrawn from market and substituted with IV paracetamole. The safety and efficacy of IV acetaminophen and IV propacetamole were shown in patients recovering from total hip and knee replacement surgery. Patients treated with IV acetaminophen (4gr/day) required 28% less morphine and reported pain intensity scores lower than those created with placebo. Patients recovering from ambulatory surgeries (including patients at risk for opioid- associated respiratory depression, nausea and ileus and patient with visceral pain following ureteral, tubal, uncomplicated laparoscopic surgeries ) and orthopedic surgery and spinal fusion could benefit from improved pain control and opioid sparing effect of IV acetaminophen. 50 The First International Congress of Regional Anesthesia and Pain Interventions and 3rd Annual Congress of ISRAPM ايلیه کىگر بیه المللی رژی وًال آوستزی ي ایىتريوشىال درد ي س مًیه کىگر سالیاو اوجمه رژی وًال آوستزی ي درد ایران Intravenous acetaminophen is an efficacious and safe treatment for emergency management of renal colic. Pretreatment with IV acetaminophen seems to be effective in attenuating pain during IV injection of propofole. To summarize, the application of IV acetaminophen is recommended in the following clinical situations: 1) Always in preferred over rectal paracetamol. 2) Impairment or inability to absorb orally administered paracetamol (such as prolonged vomiting, PONV, postoperative ileus, bowel obstruction and etc). 3) When it is imperative to totally avoid opioid or spare opioid use to avoid opioid associated side effects/sensivity (particularly if NSAIDS are contraindicated). 3-a) Respiratory depression in patients with significant risk of respiratory compromise such as moderate to severe obstructive sleep apnea, thoracic/upper abdominal surgery and impaired pulmonary function. 3-b) Sedation: -A neurologic condition that would be complicated by respiratory depression. -Diagnostic dilemma e.g. severe sepsis 3-c) Profound nausea and vomiting or severe itching

نوع سند :موضوع کنفرانس یا کارگاه (سخنرانی )
زبان سند : انگلیسی
نویسنده مسئول :علی محمدیان اردی
کلید واژه ها:استامینوفن
کلید واژه ها (انگلیسی):ACETAMINOPHEN
موضوعات :QV فارماکولوژی
WE سیستم عضلانی اسکلتی
WT بیماریهای مزمن و بیماریهای سالمندان
بخش های دانشگاهی :دانشكده پزشكي > گروه بیهوشی، زنان و زایمان
کد شناسایی :5572
ارائه شده توسط : دکتر علی محمدیان اردی
ارائه شده در تاریخ :02 اردبهشت 1393 11:42
آخرین تغییر :02 اردبهشت 1393 11:42

فقط پرسنل کتابخانه صفحه کنترل اسناد

Document Downloads

More statistics for this item...