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ANESTHETIC PHARMACOLOGY

Intravenous Administration of Propacetamol Reduces Morphine Consumption After Spinal Fusion Surgery

Joaquín Hernández-Palazón, MD, PhD^*, José A. Tortosa, MD, PhD^*, Juan F. Martínez-Lage, MD, and Domingo Pérez-Flores, MD, PhD

Departments of *Anesthesiology and Neurosurgery, Hospital Universitario ‘Virgen de la Arrixaca,‘ Murcia, Spain; and Department of Biostatistics, School of Medicine, University of Murcia, Murcia, Spain

Address correspondence and reprint requests to José A. Tortosa, MD, PhD, C/Ricardo Gil 26, 2° B, 30 002 Murcia, Spain. Address e-mail to isv01mu{at}nacom.es

We sought to determine the analgesic efficacy, opioid-sparing effects, and tolerability of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) after spinal fusion surgery. Forty-two patients undergoing spinal stabilization surgery were randomized into two groups, which were given either an IV placebo or an IV injection of 2 g propacetamol every 6 h for 3 days after surgery. The postoperative opioid analgesic requirement was assessed with a PCA device used to self-administer morphine. Pain relief was evaluated by a visual analog pain scale and by verbal rating scores of pain relief at 8-h intervals for up to 72 h after surgery. The cumulative dose of morphine at 72 h was smaller in the Propacetamol group than in the Placebo group (60.3 ± 20.5 vs 112.2 ± 39.1 mg; P < 0.001). The pain scores were significantly lower in the Propacetamol group measured at two intervals of the study, although visual analog scale pain intensity scores were smaller than 3 in both groups. Most patients in the Placebo group obtained a greater degree of sedation on postoperative Day 3 (P < 0.05). This study demonstrates the usefulness of propacetamol as an adjunct to PCA morphine in the treatment of postoperative pain after spinal fusion.

Implications: We evaluated the utility of propacetamol as an adjunct to the administration of patient-controlled analgesia morphine in the treatment of postoperative pain after spine stabilization surgery. This combination was associated with an appropriate analgesic effect and with a smaller morphine consumption.

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