•     학회명 :  2023 ASHP (American Society of Health-System Pharmacists) Midyear Clinical Meeting & Exhibition
•     기간 : 2023. 12. 3 – 7
•     장소 : Anaheim, USA
•     발표자 : Dohye Kim, Sami Yang, Joowon Chung, Hyewon Han
  • Department of Pharmacy, Asan Medical Center, South Korea

Introduction

The primary objectives of postoperative acute pain management include effective pain relief, facilitation of recovery, and ensuring patient satisfaction. Despite its FDA-boxed warning, intravenous (IV) tramadol, a narcotic, is not regulated as such in Korea and is frequently used as a first-line postoperative analgesic. However, recent reports suggest potential adverse hemodynamic effects following its administration. The aim of this study is to compare the analgesic efficacy and incidence of adverse reactions between IV acetaminophen and tramadol, used as first-line postoperative analgesics in patients undergoing gastro-related surgery. 

Method

This study included patients who underwent gastro-related surgery in a single center. A retrospective analysis was performed using information from the electronic medical records of patients who were administered either 50 mg of IV tramadol (in December 2022) or 1 g of IV acetaminophen (in March 2023) as postoperative analgesics in general wards. The analgesic efficacy was measured by Numerical Rating Scale (NRS). The difference in NRS scores before and 30 minutes after analgesic administration was used to evaluate the degree of pain relief. Furthermore, consideration was given to whether supplementary analgesics were needed. The study only included patients who received pain medication within 24 hours post-surgery. Adverse events comparison between the two groups was facilitated by collecting hemodynamic parameters (blood pressure, respiratory rate, and percutaneous oxygen saturation) and recording the incidence of post-administration nausea/vomiting and dizziness. Statistical analyses were performed using the Chi-square test or Student's t-test and p-values <0.05 was considered significant.

Results

The study enrolled 50 patients each receiving intravenous tramadol and intravenous acetaminophen respectively. Comparable demographic attributes including age, sex, and weight were observed between both groups, while a uniform post-surgical analgesic in the postoperative recovery room either IV oxycodone HCl 10 mg or IV fentanyl 50 mcg was administered across all subjects. Mean NRS scores prior to analgesic administration were identical at 6.16 in both groups (P = 0.5). Following analgesic administration, the differential NRS scores were not statistically distinct, presenting as 3.16 ± 1.50 in the tramadol group and 3.20 ± 1.55 in the acetaminophen group (P = 0.4481). Additional analgesic administration within 24 hours post-initial dosage occurred in 30% of the tramadol group and 24% of the acetaminophen group, demonstrating no statistical discrepancy (P = 0.4992). Hemodynamic parameters, such as blood pressure (BP), respiratory rate (RR) and percutaneous oxygen saturation (SpO2), were consistent before and after analgesic administration, revealing no statistical significance. 2 cases (4%) complained of nausea and vomiting and 1 cases (2%) complained of dizziness in tramadol groups, while no adverse effect attributable to acetaminophen was noticed.    

Conclusion

IV administration of acetaminophen demonstrated similar efficacy to that of IV tramadol in providing analgesic coverage, with a notably low incidence of adverse effects following gastro-related surgical procedures. These findings suggest that IV acetaminophen may serve as a safer and equally effective alternative to IV tramadol for postoperative pain management. Extrapolating from the outcomes of the current study, the use of IV acetaminophen could potentially be expanded beyond gastro-related surgeries to a wider array of surgical procedures.