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BJA Advance Access published online on March 24, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei109
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted December 22, 2004

Clinical Investigation

Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery

P. L. Moller 1*, S. Sindet-Pedersen 1, C. T. Petersen 1, G. I. Juhl 1, A. Dillenschneider 2, and L. A. Skoglund 3

1 Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
2 Neuroscience Department, Bristol-Myers Squibb, Rueil-Malmaison, France
3 Section of Dental Pharmacology and Pharmacotherapeutics, Faculty of Dentistry, University of Oslo, Norway

* To whom correspondence should be addressed.
P. L. Moller, E-mail: plm{at}dadlnet.dk


  Abstract

Background. The purpose of this randomized double-blind study was to compare the efficacy and safety of propacetamol 2 g (an i.v. acetaminophen 1 g formulation) administered as a 2-min bolus injection (n=50) or a 15-min infusion (n=50) with oral acetaminophen 1 g (n=50) or placebo (n=25) for analgesia after third molar surgery in patients with moderate to severe pain after impacted third molar removal.

Methods. All patients were evaluated for efficacy during the initial 6 h period after treatment administration (T0) and for safety during the entire week after T0.

Results. The onset of analgesia after propacetamol was shorter (3 min for bolus administration, 5 min for 15-min infusion) than after oral acetaminophen (11 min). Active treatments were significantly better for all parameters (pain relief, pain intensity, patient's global evaluation, duration of analgesia) than placebo (P<0.05). Adverse events were more frequent after propacetamol, especially pain at the injection site. Propacetamol bolus resulted in a much higher incidence of local adverse events than the infusion (propacetamol bolus 90% vs propacetamol infusion 52%) with no clinically significant benefits in terms of analgesic efficacy.

Conclusion. I.V. propacetamol, administered as a 15-min infusion, is a fast-acting analgesic agent. It is more effective in terms of onset of analgesia than a similar dose of oral acetaminophen.

Keywords: analgesic techniques, i.v.; analgesics non-opioid, acetaminophen; analgesics non-opioid, propacetamol; pain, postoperative; surgery, third molar.
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