An Investigation of Safety and Efficacy of Intravenous Paracetamol in Pain Management Following Cardiac Surgery

Document Type : Systematic review


1 Resident of Anesthesiology, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran

2 Anesthesiologist, Cardio-Thoracic Surgery & Transplant Research, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Optimum pain management immediately after surgeries can lower the possibility of pain syndrome and its following consequences. Opioids are amongst the analgesics used for postoperative pain control; however, their application can bring about several adverse effects. In this study, all the published articles regarding efficacy of Paracetamol   in post-cardiac surgery pain management were systematically reviewed.
Materials and Methods: Pubmed and Scopus were searched for relevant articles. The employed search strategy was as follows: (Paracetamol   OR Acetaminophen OR Propacetamol) AND (pain OR analgesia) AND coronary. All the English-language articles (with no time restriction), investigating the effectiveness of Acetaminophen in comparison with other analgesics or placebo, were included in the study. All the articles examining the efficacy of Paracetamol   in combination with other analgesics were excluded from the search results. Results: On the whole, our electronic search retrieved 192 articles from PubMed and 365 articles from Scopus. After screening the titles, abstracts, and full texts of the search results, only 5 English-language articles met our inclusion criteria.
Conclusion: Although Paracetamol   demonstrated considerable efficacy in minimizing application of post-operative opioids, its strength in soothing post-operative pain is not significantly different from opioids. Further, conducting randomized-controlled-trials with large sample size are necessary to accurately reveal the efficacy of Paracetamol   in curtailing application of opioids in post cardiac surgeries.


  1. Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother. 2009; 9:723-44.
  2. Mailis A, Umana M, Feindel CM. Anterior intercostal nerve damage after coronary artery bypass graft surgery with use of internal thoracic artery graft. Ann Thorac Surg. 2000; 69:1455-8.
  3. Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review. Eur J Pain. 2009; 13:719-30.
  4. Layzell M. Current interventions and approaches to postoperative pain management. Br J Nurs. 2008; 17:414-9.
  5. Ranucci M, Cazzaniga A, Soro G, Isgro G, Rossi R, Pavesi M. Postoperative analgesia for early extubation after cardiac surgery. A prospective, randomized trial. Minerva Anestesiol. 1999; 65:859-65.
  6. Avellaneda C, Gomez A, Martos F, Rubio M, Sarmiento J, de la Cuesta FS. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propacetamol 1 g on haemodynamic parameters and postoperative pain after heart surgery. Eur J Anaesthesiol. 2000; 17:85-90.
  7. Jahangiri Fard A, Babaee T, Alavi SM, Nasiri AA, Ghoreishi SM, Noori NM, et al. Intravenous patient-controlled remifentanil versus paracetamol in post-operative pain management in patients undergoing coronary artery bypass graft surgery. Anesth Pain Med. 2014; 4:e19862.
  8. Lahtinen P, Kokki H, Hendolin H, Hakala T, Hynynen M. Propacetamol as adjunctive treatment for postoperative pain after cardiac surgery. Anesth Analg. 2002; 95:813-9.
  9. Pettersson PH, Jakobsson J, Öwall A. Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2005; 19:306-9.
  10.  Varrassi G, Marinangeli F, Agro F, Aloe L, De Cillis P, De Nicola A, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg. 1999; 88:611-6.
  11.  Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, Perez-Flores D. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg. 2001; 92:1473-6.
  12. Peduto VA, Ballabio M, Stefanini S. Efficacy of propacetamol in the treatment of postoperative pain. Morphine-sparing effect in orthopedic surgery. Italian Collaborative Group on Propacetamol. Acta Anaesthesiol Scand. 1998; 42:293-8.
  13. Fletcher D, Negre I, Barbin C, Francois A, Carreres C, Falgueirettes C, et al. Postoperative analgesia withiv propacetamol and ketoprofen combination after disc surgery. Can J Anaesth. 1997; 44:479-85.
  14.  Zhou TJ, Tang J, White PF. Propacetamol versus ketorolac for treatment of acute postoperative pain after total hip or knee replacement. Anesth Analg. 2001; 92:1569-75.
  15. Piletta P, Porchet HC, Dayer P. Central analgesic effect of acetaminophen but not of aspirin. Clin Pharmacol Ther. 1991; 49:350-4.
  16. Fayaz MK, Abel RJ, Pugh SC, Hall JE, Djaiani G, Mecklenburgh JS. Opioid-sparing effects of diclofenac and paracetamol lead to improved outcomes after cardiac surgery. J Cardiothorac Vasc Anesth. 2004; 18:742-7.
  17.  Mushambi MC, Rowbotham DJ, Bailey SM. Gastric emptying after minor gynaecological surgery. Anaesthesia. 1992; 47:297-9.