Question:How do single dose intravenous propacetamol or intravenous paracetamol(acetaminophen) compare with other drug treatment in adults with acute postoperative pain?

Clinical Answer:

When given alone, single dose IV propacetamol or IV paracetamol (acetaminophen) seem to be partly effective analgesics. It is advisable to consider them as adjunctive therapy only. 

Randomized controlled trials including around 200 participants showed similar effectiveness between single-dose IV propacetamol and IV paracetamol (acetaminophen) over NSAIDs or opioids in terms of pain relief, additional analgesia requirements or patient global self-evaluation in any post-operative period.

A single trial with around 175 people suggested that taking IV propacetamol reduced opioid consumption over four hours after abdominal or orthopedic surgery compared with people taking NSAIDs. It was also associated with reduced GI disorders in the post-operative period compared with opioids. There is one IV preparation of acetaminophen available in the US and propacetamol, the pro-drug form of acetaminophen, it is not available

Full outcome data is detailed below:

1.Propacetamol or paracetamol (acetaminophen) versus NSAIDs

  • Population, Intervention, Comparator

    Population:

    Adult patients undergoing abdominal or orthopedic surgery

    Intervention:

    2 g propacetamol IV over 2 min or 1 g paracetamol (acetaminophen)  in 100 ml over 15 min

    Comparator:

    275 mg diclofenac IM or 40 mg IV parecoxib or 30 mg ketorolac IV

  • OUTCOME 1.1: Number of patients with > 50% pain relief over 4 hours

    Risk of bias of studies:

    The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

    Narrative result:

    Three RCTs with 223 participants that compared propacetamol versus NSAIDs found no statistically significant difference between groups.

    Relative effect or mean difference:

    There was no statistically significant difference between groups (RR 1.08, 95% CI 0.86 to 1.34).

    Forest plot from Cochrane Review

    Absolute effect:

    There was no statistically significant difference between groups.

    Reference:
    Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
    • OUTCOME 1.2: Number of patients with > 50% pain relief over 6 hours

      Risk of bias of studies:

      The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

      Narrative result:

      Two RCTs with 143 participants that compared propacetamol versus NSAIDs found no statistically significant difference between groups.

      Relative effect or mean difference:

      There was no statistically significant difference between groups (RR 0.75, 95% CI 0.56 to 1.02).

      Forest plot from Cochrane Review

      Absolute effect:

      There was no statistically significant difference between groups.

      Reference:
      Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
      • OUTCOME 1.3: Number of patients requiring rescue medication

        Risk of bias of studies:

        The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

        Narrative result:

        Three RCTs with 189 participants that compared propacetamol versus NSAIDs found no statistically significant difference between groups.

        Relative effect or mean difference:

        There was no statistically significant difference between groups (RR 1.23, 95% CI 0.86 to 1.77).

        Forest plot from Cochrane Review

        Absolute effect:

        There was no statistically significant difference between groups.

        Reference:
        Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
        • OUTCOME 1.4: Opioid consumption over 4 hours

          Risk of bias of studies:

          The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

          Narrative result:

          Two RCTs with 254 participants found that propacetamol or paracetamol (acetaminophen) reduced opioid consumption over 4 hours compared with NSAIDS. Most of the data were in participants taking propacetamol so subgroup analyses assessing each drug separately were inconclusive. Click below for full details.

          Relative effect or mean difference:

          There was a statistically significant difference between groups, in favor of Active (mean difference -0.20 mg, 95% CI -0.37 mg to -0.02 mg).

          Forest plot from Cochrane Review

          Reference:
          Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
          • Subgroup analysis 1.4.1: Subgroup: Propacetamol vs NSAIDs
            Risk of bias of studies:

            The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

            Narrative result:

            One RCT with 176 participants found that propacetamol reduced opioid consumption over 4 hours compared with NSAIDS.

            Relative effect or mean difference:

            There was a statistically significant difference between groups, in favor of propacetamol (mean difference -0.20 mg, 95% CI -0.38 mg to -0.02 mg).

            Forest plot from Cochrane Review

            Reference:
            Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
          • Subgroup analysis 1.4.2: Subgroup: Paracetamol (acetaminophen) vs NSAIDs
            Risk of bias of studies:

            The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

            Narrative result:

            One RCT with 78 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

            Relative effect or mean difference:

            There was no statistically significant difference between groups (mean difference 0.10 mg, 95% CI -1.41 mg to 1.61 mg).

            Forest plot from Cochrane Review

            Reference:
            Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
        • OUTCOME 1.5: Opioid consumption over 6 hours

          Risk of bias of studies:

          The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

          Narrative result:

          Five RCTs with 380 participants, assessing propacetamol or paracetamol (acetaminophen) , found no statistically significant difference between groups. The reviewers did not perform subgroup analyses of each drug separately at this time point.

          Relative effect or mean difference:

          There was no statistically significant difference between groups (mean difference -0.14 mg, 95% CI -0.39 mg to 0.11 mg).

          Forest plot from Cochrane Review

          Reference:
          Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
          • OUTCOME 1.6: Global evaluation rated as good/satisfied or excellent/very satisfied

            Risk of bias of studies:

            The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

            Narrative result:

            Seven RCTs with 613 participants found no statistically significant difference between groups. Subgroup analysis by drug found similar results to the main analysis.

            Relative effect or mean difference:

            There was no statistically significant difference between groups (RR 0.92, 95% CI 0.84 to 1.01).

            Forest plot from Cochrane Review

            Absolute effect:

            There was no statistically significant difference between groups.

            Reference:
            Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
            • OUTCOME 1.7: Adverse events: Nausea

              Risk of bias of studies:

              The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

              Narrative result:

              Four RCTs with 472 participants found no statistically significant difference between groups. Subgroup analysis by drug found similar results to the main analysis.

              Relative effect or mean difference:

              There was no statistically significant difference between groups (RR 1.15, 95% CI 0.92 to 1.44).

              Forest plot from Cochrane Review

              Absolute effect:

              There was no statistically significant difference between groups.

              Reference:
              Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
              • OUTCOME 1.8: Adverse events: Vomiting

                Risk of bias of studies:

                The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                Narrative result:

                Four RCTs with 472 participants found no statistically significant difference between groups. Subgroup analysis by drug found similar results to the main analysis.

                Relative effect or mean difference:

                There was no statistically significant difference between groups (RR 1.27, 95% CI 0.85 to 1.88).

                Forest plot from Cochrane Review

                Absolute effect:

                There was no statistically significant difference between groups.

                Reference:
                Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                • OUTCOME 1.9: Adverse events: Headache

                  Risk of bias of studies:

                  The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                  Narrative result:

                  Two RCTs with 232 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                  Relative effect or mean difference:

                  There was no statistically significant difference between groups (RR 1.78, 95% CI 0.76 to 4.16).

                  Forest plot from Cochrane Review

                  Absolute effect:

                  There was no statistically significant difference between groups.

                  Reference:
                  Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                  • OUTCOME 1.10: Adverse events: Pruritus

                    Risk of bias of studies:

                    The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                    Narrative result:

                    Four RCTs with 312 participants found no statistically significant difference between groups. Subgroup analysis by drug found similar results to the main analysis.

                    Relative effect or mean difference:

                    There was no statistically significant difference between groups (RR 0.85, 95% CI 0.42 to 1.73).

                    Forest plot from Cochrane Review

                    Absolute effect:

                    There was no statistically significant difference between groups.

                    Reference:
                    Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                    • OUTCOME 1.11: Adverse events: Sedation

                      Risk of bias of studies:

                      The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                      Narrative result:

                      Two RCTs with 70 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                      Relative effect or mean difference:

                      There was no statistically significant difference between groups (RR 3.67, 95% CI 0.63 to 21.22).

                      Forest plot from Cochrane Review

                      Absolute effect:

                      There was no statistically significant difference between groups.

                      Reference:
                      Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                      • OUTCOME 1.12: Adverse events: GI disorders

                        Risk of bias of studies:

                        The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                        Narrative result:

                        One RCT with 200 participants found no statistically significant difference between groups.

                        Relative effect or mean difference:

                        There was no statistically significant difference between groups (RR 0.60, 95% CI 0.28 to 1.31).

                        Forest plot from Cochrane Review

                        Absolute effect:

                        There was no statistically significant difference between groups.

                        Reference:
                        Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]

                        2.Propacetamol versus opioids

                        • Population, Intervention, Comparator

                          Population:

                          Adult patients undergoing various elective surgeries

                          Intervention:

                          2 g propacetamol in 150 ml normal saline over 15 minutes

                          Comparator:

                          10 mg morphine IV or 20 mg nefopam over 60 min or 50 mg meperidine IM or tramadol 1.5 mg/kg

                        • OUTCOME 2.1: Number of patients with > 50% pain relief over 4 hours

                          Risk of bias of studies:

                          The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                          Narrative result:

                          One RCT with 61 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                          Relative effect or mean difference:

                          There was no statistically significant difference between groups (RR 1.16, 95% CI 0.85 to 1.59).

                          Forest plot from Cochrane Review

                          Absolute effect:

                          There was no statistically significant difference between groups.

                          Reference:
                          Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                          • OUTCOME 2.2: Number of patients with > 50% pain relief over 6 hours

                            Risk of bias of studies:

                            The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                            Narrative result:

                            One RCT with 40 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                            Relative effect or mean difference:

                            There was no statistically significant difference between groups (RR 0.95, 95% CI 0.83 to 1.09).

                            Forest plot from Cochrane Review

                            Absolute effect:

                            There was no statistically significant difference between groups.

                            Reference:
                            Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                            • OUTCOME 2.3: Number of patients requiring rescue medication

                              Risk of bias of studies:

                              The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                              Narrative result:

                              Two RCTs with 139 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                              Relative effect or mean difference:

                              There was no statistically significant difference between groups (RR 1.83, 95% CI 0.72 to 4.64).

                              Forest plot from Cochrane Review

                              Absolute effect:

                              There was no statistically significant difference between groups.

                              Reference:
                              Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                              • OUTCOME 2.4: Opioid consumption over 4 hours

                                Risk of bias of studies:

                                The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                Narrative result:

                                One RCT with 80 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                Relative effect or mean difference:

                                There was no statistically significant difference between groups (mean difference -1.00 mg, 95% CI -3.09 mg to 1.09 mg).

                                Forest plot from Cochrane Review

                                Reference:
                                Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                • OUTCOME 2.5: Opioid consumption over 6 hours

                                  Risk of bias of studies:

                                  The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                  Narrative result:

                                  One RCT with 80 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                  Relative effect or mean difference:

                                  There was no statistically significant difference between groups (mean difference -0.50 mg, 95% CI -3.01 mg to 2.01 mg).

                                  Forest plot from Cochrane Review

                                  Reference:
                                  Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                  • OUTCOME 2.6: Global evaluation rated as good/satisfied or excellent/very satisfied

                                    Risk of bias of studies:

                                    The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                    Narrative result:

                                    Two RCTs with 116 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                    Relative effect or mean difference:

                                    There was no statistically significant difference between groups (RR 0.94, 95% CI 0.79 to 1.11).

                                    Forest plot from Cochrane Review

                                    Absolute effect:

                                    There was no statistically significant difference between groups.

                                    Reference:
                                    Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                    • OUTCOME 2.7: Adverse events: Nausea

                                      Risk of bias of studies:

                                      The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                      Narrative result:

                                      Two RCTs with 107 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                      Relative effect or mean difference:

                                      There was no statistically significant difference between groups (RR 0.79, 95% CI 0.32 to 1.91).

                                      Forest plot from Cochrane Review

                                      Absolute effect:

                                      There was no statistically significant difference between groups.

                                      Reference:
                                      Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                      • OUTCOME 2.8: Adverse events: Vomiting

                                        Risk of bias of studies:

                                        The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                        Narrative result:

                                        Two RCTs with 107 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                        Relative effect or mean difference:

                                        There was no statistically significant difference between groups (RR 0.51, 95% CI 0.10 to 2.62).

                                        Forest plot from Cochrane Review

                                        Absolute effect:

                                        There was no statistically significant difference between groups.

                                        Reference:
                                        Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                        • OUTCOME 2.9: Adverse events: Pruritus

                                          Risk of bias of studies:

                                          The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                          Narrative result:

                                          Two RCTs with 107 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                          Relative effect or mean difference:

                                          There was no statistically significant difference between groups (RR 0.34, 95% CI 0.10 to 1.19).

                                          Forest plot from Cochrane Review

                                          Absolute effect:

                                          There was no statistically significant difference between groups.

                                          Reference:
                                          Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                          • OUTCOME 2.10: Adverse events: GI disorders

                                            Risk of bias of studies:

                                            The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                            Narrative result:

                                            Two RCTs with 91 participants found that propacetamol reduced the proportion of people with GI disorders compared with opioid.

                                            Relative effect or mean difference:

                                            There was a statistically significant difference between groups, in favor of Propacetamol (RR 0.26, 95% CI 0.10 to 0.63).

                                            Forest plot from Cochrane Review

                                            Absolute effect:

                                            11 per 100 people (95% CI 5 to 27) with propacetamol compared with 43 per 100 people with opioid.

                                            Reference:
                                            Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]

                                            3.Propacetamol versus paracetamol (acetaminophen) 

                                            • Population, Intervention, Comparator

                                              Population:

                                              Adult patients undergoing gynecological, orthopedic or dental surgery

                                              Intervention:

                                              Propacetamol 2 g in 100 ml solution

                                              Comparator:

                                              Paracetamol (acetaminophen) 1g IV in 100 ml solution over 15 min

                                            • OUTCOME 3.1: Number of patients with > 50% pain relief over 4 hours

                                              Risk of bias of studies:

                                              The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                              Narrative result:

                                              Three RCTs with 361 participants found no statistically significant difference between groups.

                                              Relative effect or mean difference:

                                              There was no statistically significant difference between groups (RR 0.98, 95% CI 0.77 to 1.24).

                                              Forest plot from Cochrane Review

                                              Absolute effect:

                                              There was no statistically significant difference between groups.

                                              Reference:
                                              Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                              • OUTCOME 3.2: Number of patients with > 50% pain relief over 6 hours

                                                Risk of bias of studies:

                                                The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                                Narrative result:

                                                Three RCTs with 361 participants found no statistically significant difference between groups.

                                                Relative effect or mean difference:

                                                There was no statistically significant difference between groups (RR 0.94, 95% CI 0.73 to 1.20).

                                                Forest plot from Cochrane Review

                                                Absolute effect:

                                                There was no statistically significant difference between groups.

                                                Reference:
                                                Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                                • OUTCOME 3.3: Number of patients requiring rescue medication

                                                  Risk of bias of studies:

                                                  The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                                  Narrative result:

                                                  One RCT with 161 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                                  Relative effect or mean difference:

                                                  There was no statistically significant difference between groups (RR 1.33, 95% CI 0.82 to 2.17).

                                                  Forest plot from Cochrane Review

                                                  Absolute effect:

                                                  There was no statistically significant difference between groups.

                                                  Reference:
                                                  Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                                  • OUTCOME 3.4: Opioid consumption over 6 hours

                                                    Risk of bias of studies:

                                                    The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                                    Narrative result:

                                                    One RCT with 98 participants found no statistically significant difference between groups but may have been underpowered to detect clinically meaningful differences.

                                                    Relative effect or mean difference:

                                                    There was no statistically significant difference between groups (mean difference -0.40, 95% CI -4.15 to 3.35).

                                                    Forest plot from Cochrane Review

                                                    Reference:
                                                    Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                                    • OUTCOME 3.5: Global evaluation rated as good/satisfied or excellent/very satisfied

                                                      Risk of bias of studies:

                                                      The reviewers did not perform a GRADE assessment of the quality of the evidence. Overall around 60% of the studies in the systematic review were at low risk of performance, detection and attrition bias but at unclear risk of selection bias.

                                                      Narrative result:

                                                      Two RCTs with 263 participants found no statistically significant difference between groups.

                                                      Relative effect or mean difference:

                                                      There was no statistically significant difference between groups (RR 0.98, 95% CI 0.83 to 1.15).

                                                      Forest plot from Cochrane Review

                                                      Absolute effect:

                                                      There was no statistically significant difference between groups.

                                                      Reference:
                                                      Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]
                                                      • OUTCOME 3.6: Adverse events

                                                        Narrative result:

                                                        The reviewers found no studies assessing this outcome.

                                                        Reference:
                                                        Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]

                                                        Additional Information:

                                                        DOI

                                                        10.1002/cca.323

                                                        Publication Dates

                                                        1. Published Online: 19 MAR 2014

                                                        CCA derived from

                                                        Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MBD, Farhat T, Schumann R. Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126. DOI: 10.1002/14651858.CD007126.pub2. [Review search date: May 2010]

                                                        How to Cite

                                                        How do single dose intravenous propacetamol or intravenous paracetamol(acetaminophen) compare with other drug treatment in adults with acute postoperative pain? Christopher Bunt (MD) (on behalf of Cochrane Clinical Answers Editors). Cochrane Clinical Answers 2012. DOI: 10.1002/cca.323.

                                                        Further Information

                                                        • CCA Associate editor: Christopher Bunt (MD), Assistant Professor, Dept. of Family Medicine, Uniformed Services University, Bethesda, MD, USA.
                                                        • CCA Editor: Karen Pettersen. Correspondence to kpettersen@wiley.com.