Haemodynamic effects of parenteral vs. enteral paracetamol in critically ill patients: a randomised controlled trial

Kelly, S.J. et al. (2016) Anaesthesia. 71. pp. 1153-62

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Introduction: Reports in the literature have suggested that paracetamol is associated with significant hypotension, a potentially important interaction for labile critically ill patients. These authors carried out a single-centre, prospective, open-label, randomised, parallel-arm, active-control trial, designed to determine the incidence of hypotension following the administration of paracetamol to critically ill patients.

Methods: A total of 50 adult patients receiving paracetamol for analgesia or pyrexia were randomly assigned to receive either the parenteral or enteral formulation of the drug. Paracetamol concentrations were measured at baseline and at multiple time points over 24 hours.

Results: The maximal plasma paracetamol concentration was significantly different between routes; 156 versus 73 µmol/L (p=0.0005) following the first dose of parenteral or enteral paracetamol, respectively. Sixteen hypotensive events occurred in 12 patients: parenteral n=12; enteral n=4. The incident rate ratio for parenteral versus enteral paracetamol was 2.94 (95% confidence interval 0.97 to 8.92; p=0.06).

Conclusions: The authors conclude that the incidence of hypotension associated with paracetamol administration is higher than previously reported and tends to be more frequent with parenteral paracetamol.

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