Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit

J Crit Care. 2010 Sep;25(3):458-62. doi: 10.1016/j.jcrc.2009.12.012. Epub 2010 Mar 1.


Background: This study assessed the analgesic efficacy, side effects, and time to extubation of intravenous paracetamol when administered as an adjuvant to intravenous meperidine after major surgery in intensive care unit (ICU).

Material: Patients were randomized postoperatively into 2 groups in ICU. Patients received either 100 mL of serum saline intravenous (IV) every 6 hours and IV meperidine (n = 20 group M) or IV paracetamol 1 g every 6 hours and IV meperidine (n = 20, group MP) into a peripheral vein for 24 hours. Behavioral Pain Scale (BPS) is used until extubation, and visual analog score (VAS) is used after extubation. When BPS and VAS values were more than 4, meperidine, 1 mg/kg IV, was administered and noted in 2 groups. Pain scores, total meperidine consumption, time to extubation, sedation scores, and side effects are 24-hour postoperatively noted.

Results: Behavioral Pain Scale and VAS scores are significantly lower in group paracetamol-meperidine at 24 hours (P < .05). In group MP, postoperative meperidine consumption (76.75 ± 18.2 mg vs. 198 ± 66.4 mg) and extubation time (64.3 ± 40.6 min vs. 204.5 ± 112.7 min) were lower than in group M (P < .01). In addition to, postoperative nausea-vomiting and sedation scores were significantly lower in group MP when compared with group M (P < .05).

Conclusion: We have demonstrated important clinical benefits by the addition of 4 g/d of paracetamol to meperidine after major surgery. This benefit has been shown in a range of patients under routine clinical conditions and therefore has important practical consequences in ICU. These data suggest that intravenous paracetamol is a useful component of the multimodal analgesia model, especially after major surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / administration & dosage*
  • Aged
  • Analgesics, Non-Narcotic / administration & dosage*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects
  • Chemotherapy, Adjuvant
  • Female
  • Humans
  • Infusions, Intravenous
  • Intensive Care Units
  • Intubation, Intratracheal
  • Male
  • Meperidine / administration & dosage
  • Meperidine / adverse effects
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / prevention & control*
  • Postoperative Care*
  • Time Factors
  • Treatment Outcome


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Acetaminophen
  • Meperidine