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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making
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Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making

机译：静脉内与口腔乙酰氨基酚用于疼痛：系统审查当前证据支持临床决策

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Background: Intravenous (IV) acetaminophen is increasingly used around the world for pain control for a variety of indications. However, it is unclear whether IV administration offers advantages over oral administration. Objective: To identify, summarize, and critically evaluate the literature comparing analgesic efficacy, safety, and pharmacokinetics for IV and oral dosage forms of acetaminophen. Data Sources: A literature search of the PubMed, Embase, and International Pharmaceutical Abstracts databases was supplemented with keyword searches of Science Direct, Wiley Library Online, and Springer Link databases for the period 1948 to November 2014. The reference lists of identified studies were searched manually. Study Selection and Data Extraction: Randomized controlled trials comparing IV and oral dosage forms of acetaminophen were included if they assessed an efficacy, safety, or pharmacokinetic outcome. For each study, 2 investigators independently extracted data (study design, population, interventions, follow-up, efficacy outcomes, safety outcomes, pharmacokinetic outcomes, and any other pertinent information) and completed risk-of-bias assessments. Data Synthesis: Six randomized clinical trials were included. Three of the studies reported outcomes pertaining to efficacy, 4 to safety, and 4 to pharmacokinetics. No clinically significant differences in efficacy were found between the 2 dosage forms. Safety outcomes were not reported consistently enough to allow adequate assessment. No evidence was found to suggest that increased bioavailability of the IV formulation enhances efficacy outcomes. For studies reporting clinical outcomes, the results of risk-of-bias assessments were largely unclear. Conclusions: For patients who can take an oral dosage form, no clear indication exists for preferential prescribing of IV acetaminophen. Decision-making must take into account the known adverse effects of each dosage form and other considerations such as convenience and cost. Future studies should assess multiple-dose regimens over longer periods for patients with common pain indications such as cancer, trauma, and surgery.
机译：背景：静脉内（IV）乙酰氨基酚越来越多地用于世界各地的疼痛控制，适合各种适应症。但是，目前尚不清楚IV管理是否提供了口服管理的优势。目的：识别，总结，统计和批判性地评估抗乙酰氨基酚的镇痛疗效，安全性和药代动力学的文献。数据来源：对PubMed，Embase和International Pharmaceutical摘要数据库进行了文献搜索，并附有科学直接，Wiley Library在线和2014年11月期间的科学直接，Wiley Library Online和Springer Link数据库的关键字搜索。搜查了所识别研究的参考列表手动。学习选择和数据提取：如果评估疗效，安全性或药代动力学结果，则包括随机对照试验比较乙酰氨基酚的乙酰氨基酚的组织。对于每项研究，2名调查员独立提取数据（研究设计，人口，干预，后续，疗效结果，安全结果，药代动力学结果以及任何其他相关信息），并完成了偏见风险评估。数据合成：包括六种随机临床试验。其中三项研究报告了与疗效有关的结果，4至安全性，4种药代动力学。在2剂型之间发现了疗效效果的临床上显着差异。安全结果并未始终报告足以允许足够的评估。发现没有证据表明IV制剂的增加的生物利用度会增强疗效结果。对于报告临床结果的研究，偏倚风险评估的结果在很大程度上不清楚。结论：对于可以服用口服剂型的患者，不存在对IV乙酰氨基酚的优先规定的明确指示。决策必须考虑每个剂型和其他考虑因素的众所周知的不良影响，例如便利性和成本。未来的研究应评估多剂量方案，对患有癌症，创伤和手术等常见疼痛适应症的患者的多剂量方案。

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