Purpose

Acetaminophen is commonly used for post-operative analgesia following liver resection. It is metabolised by the liver and appropriate administration and dosage is in question in in patients undergoing hepatectomy. A systematic review was conducted to investigate safety and efficacy of acetaminophen use.

Methods

MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar were searched for instances of toxicity, liver dysfunction, and analgesic efficacy in patients undergoing hepatectomy.

Results

Two randomised controlled trials and four prospective observational studies were included. The studies were of moderate quality. Four studies investigated post-operative levels of acetaminophen and its urinary metabolites, finding no evidence of toxicity. One study noted that glutathione levels decreased but not to clinically deficient levels. Administration of acetaminophen plus morphine versus morphine alone did not increase adverse events and a morphine sparing effect of acetaminophen was demonstrated in two studies.

Conclusion

Use of acetaminophen for adult patients undergoing liver resection surgery as post-operative analgesia at a standard dosage is safe for baseline analgesia. All studies analysed support that toxicity is not reached; and that acetaminophen provides a morphine sparing effect without adverse effects. Acetaminophen dose reduction should be considered in patients where extra risk factors for hepatotoxicity are present.

中文翻译：

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肝切除术后使用对乙酰氨基酚的疗效和安全性：系统评价

目的

对乙酰氨基酚常用于肝切除术后镇痛。它由肝脏代谢，在接受肝切除术的患者中，适当的给药和剂量是有问题的。进行了系统评价以调查对乙酰氨基酚使用的安全性和有效性。

方法

对 MEDLINE、EMBASE、PubMed、Web of Science 和 Google Scholar 进行了搜索，以了解肝切除术患者的毒性、肝功能障碍和镇痛效果。

结果

包括两项随机对照试验和四项前瞻性观察研究。这些研究质量中等。四项研究调查了对乙酰氨基酚及其尿液代谢物的术后水平，没有发现任何毒性证据。一项研究指出，谷胱甘肽水平下降但未达到临床缺乏水平。对乙酰氨基酚加吗啡与单独使用吗啡相比不会增加不良事件，两项研究证实了对乙酰氨基酚的吗啡节约作用。

结论

对接受肝切除手术的成年患者使用标准剂量的对乙酰氨基酚作为术后镇痛剂对于基线镇痛是安全的。所有分析的研究都支持未达到毒性；并且对乙酰氨基酚提供吗啡节省作用而没有副作用。对于存在额外肝毒性危险因素的患者，应考虑减少对乙酰氨基酚的剂量。