Postoperative pain management using high-dose oral acetaminophen for enhanced recovery after colorectal cancer surgery.

IF 1.7 4区医学 Q2 SURGERY Surgery Today Pub Date : 2024-11-13 DOI:10.1007/s00595-024-02962-3

Shinya Urakawa, Tatsushi Shingai, Junichiro Kato, Shinya Kidogami, Tadafumi Fukata, Hisashi Nishida, Hiroyoshi Takemoto, Hiroaki Ohigashi, Takayuki Fukuzaki

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Abstract

Purpose: Postoperative pain management is important for enhanced recovery. High-dose oral acetaminophen is effective; however, the safety of its long-term use has not been established in gastrointestinal surgeries. This study aimed to investigate drug-induced liver injury (DILI) in patients with colorectal cancer using high-dose acetaminophen.

Methods: One hundred sixty-eight consecutive colorectal cancer using high-dose oral acetaminophen (3600 mg/day between postoperative day 1 and 7) were enrolled.

Results: One hundred forty-nine patients (88.7%) completed the administration of high-dose oral acetaminophen. DILI occurred in 58 patients (34.5%), and the cumulative incidence rates were 20.4% and 37.9% on postoperative 6 and 7, respectively. The severity of liver injury was grade 1 in all cases and returned to normal without treatment. Patients with DILI had a higher frequency of dyslipidemia (44.8% vs. 23.6%, P = 0.0047) and M1 staging (10.3% vs. 1.0%, P = 0.0036). A multivariate analysis showed that the presence of dyslipidemia (OR 2.61, P = 0.0067) and M1 stage (OR 12.4, P = 0.0053) were independent risk factors for DILI.

Conclusion: The long-term use of high-dose oral acetaminophen in colorectal cancer patients enrolled in enhanced recovery protocols is feasible. Moreover, the presence of dyslipidemia and M status are risk factors for DILI.

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使用大剂量口服对乙酰氨基酚控制术后疼痛，促进结直肠癌手术后的恢复。

目的：术后止痛对促进康复非常重要。大剂量口服对乙酰氨基酚疗效显著，但其在胃肠道手术中长期使用的安全性尚未得到证实。本研究旨在调查使用大剂量对乙酰氨基酚的结直肠癌患者药物性肝损伤（DILI）的情况：结果：149 名结肠直肠癌患者（88 人）在术后第 1 天和第 7 天之间口服大剂量对乙酰氨基酚（3600 毫克/天）：149名患者（88.7%）完成了大剂量口服对乙酰氨基酚的治疗。58名患者（34.5%）发生了DILI，术后第6天和第7天的累计发生率分别为20.4%和37.9%。所有病例的肝损伤严重程度均为 1 级，无需治疗即可恢复正常。DILI患者出现血脂异常（44.8%对23.6%，P=0.0047）和M1分期（10.3%对1.0%，P=0.0036）的频率较高。多变量分析显示，血脂异常（OR 2.61，P = 0.0067）和M1分期（OR 12.4，P = 0.0053）是DILI的独立风险因素：结直肠癌患者在强化康复方案中长期使用大剂量口服对乙酰氨基酚是可行的。此外，血脂异常和 M 状态是导致 DILI 的风险因素。

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来源期刊

Surgery Today 医学-外科

CiteScore

4.90

自引率

4.00%

发文量

208

审稿时长

1 months

期刊介绍： Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it"). The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.