Opioids use reduction by intravenous acetaminophen in controlling pain in intubated patients
Presence of endotracheal tube (ETT) can induce a significant pain, even in a patient not completely conscious. There are many ways to estimate the amount of pain in such patients who cannot communicate verbally with their caregivers. Most of these tools are simple and offer a rapid way to measure and monitor the amount of pain in these patients during hospitalization.
There are enormous pharmacological and non-pharmacological ways to manage pain. Morphine sulfate is the most popular medication of pain management in patients hospitalized to the Intensive Care Units (ICUs). Unfortunately, its use is accompanied with some complications such as central nervous system and respiratory suppression, nausea/vomiting, histamine release, and consequent fall in blood pressure (BP) level.
Acetaminophen is an antipyretic and analgesic agent, and it is commonly used to relieve mild to moderate pain with different etiologies. Considering the fact that in patients in need of critical care, intravenous (IV) acetaminophen has less complications while being injected and afterward compared to IV morphine sulfate, a study was done to evaluate the effect of acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to ICU. Although, there are many studies which have showed its effectiveness on decreasing the need to IV narcotics in pain management. A study was conducted to target the intubated patients in ICU to check the need of IV narcotics in pain management. The behavioral pain scale was used for the pain measurement. All of the patients received 1g, IV acetaminophen after every 6h during the 1st and 3rd days of admission and placebo during the 2nd and 4th days. Total dose of morphine sulfate needed, its complications and the BPS scores at the end of every 6h interval were compared.
In the trial, total 40 patients were enrolled. After analysis, it was observed that the mean pain scores were significantly lower in the 2nd and 4th days in which the patients had received just morphine sulfate as compared to the 1st and 3rd days in which the patients had received acetaminophen in addition to morphine sulfate too. It was also noticed that cumulative dose of morphine sulfate used was significantly higher in the 1st and 3rd days than 2nd and 4th days.
Results indicated that IV acetaminophen had no effect on decreasing the BPs and need of morphine sulfate in intubated patients admitted to ICU. Although, the study failed to show that as a multimodal analgesia, IV acetaminophen could decrease the cumulative dose of opiates and its complications in intubated patients in ICU but researchers said that IV acetaminophen did not effect on pain reduction in intubated patients which were admitted to the ICU.