Skip to main content
SpringerLink
Log in

Paracetamol für die perioperative Analgesie

Alte Substanz – neue Erkenntnisse

Paracetamol for perioperative analgesia

Old substance – new insights

  • Klinische Pharmakologie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Paracetamol (Acetaminophen) gehört für die Indikation „Fieber“ und „leichte bis mittelschwere Schmerzen“ zu den umsatzstärksten Medikamenten in Deutschland und vielen anderen Ländern. Dies beruht maßgeblich auf den unterschiedlichen Applikationsmöglichkeiten und dem vermeintlich geringen Nebenwirkungspotenzial. In den letzten Jahren konnten durch verschiedene Studien einige Fragen hinsichtlich der möglichen Wirkmechanismen beantwortet werden. Noch viel wichtiger, nicht zuletzt aufgrund der kritischen Diskussion hinsichtlich schwerwiegender Nebenwirkungen anderer Nichtopioidanalgetika (NOPA), wie Zyklooxygenase- (COX-)2-Hemmer oder Metamizol, begann auch eine intensive Untersuchung des Risiko-Nutzen-Potenzials von Paracetamol für die Therapie postoperativer Schmerzen. In dem folgenden Übersichtsbeitrag zeigen die Autoren die Ergebnisse neuerer Untersuchungen bezüglich der Wirksamkeit und potenzieller Nebenwirkungen von Paracetamol auf und stellen einen klinischen Bezug her. Als Schlussfolgerung soll der Stellenwert von Paracetamol für die postoperative Schmerztherapie eingeschätzt werden.

Abstract

Since paracetamol was first synthesized in 1878 it has become one of the most popular and widely used drugs for the first-line treatment of fever and pain. The reasons for this popularity are a wide variety of formulations, an assumed positive safety record and the wide availability as an over-the-counter drug. However, recently several studies questioned the positive risk-benefit ratio of paracetamol for postoperative pain by observing several possible adverse effects and limitations. The aim of the present review is to give an update of the recent literature on the efficacy of paracetamol for postoperative pain and on the value of the clinical relevance of different adverse effects of paracetamol. Finally, based on the current findings the authors try to assess the role of paracetamol for the treatment of postoperative pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. (PhVWP) PWP (2010) http://www.ema.europa.eu/pdfs/human/phvwp/17301110en.pdf

  2. Allegaert K, Naulaers G (2010) Haemodynamics of intravenous paracetamol in neonates. Eur J Clin Pharmacol, doi 10.1007/s00228-010-0860-z

  3. Anderson BJ (2008) Paracetamol (Acetaminophen): mechanisms of action. Paediatr Anaesth 18:915–921

    Article  PubMed  Google Scholar 

  4. Anderson BJ, Allegaert K (2009) Intravenous neonatal paracetamol dosing: the magic of 10 days. Paediatr Anaesth 19:289–295

    Article  PubMed  Google Scholar 

  5. Anderson BJ, Holford NH, Woollard GA, Chan PL (1998) Paracetamol plasma and cerebrospinal fluid pharmacokinetics in children. Br J Clin Pharmacol 46:237–243

    Article  CAS  PubMed  Google Scholar 

  6. Anderson BJ, Holford NHG, Woollard GA et al (1999) Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology 90:411–421

    Article  CAS  PubMed  Google Scholar 

  7. Arana A, Morton NS, Hansen TG (2001) Treatment with paracetamol in infants. Acta Anaesthesiol Scand 45:20–29

    Article  CAS  PubMed  Google Scholar 

  8. Bannwarth B, Netter P, Lapicque F et al (1992) Plasma and cerebrospinal fluid concentrations of paracetamol after a single intravenous dose of propacetamol. Br J Clin Pharmacol 34:79–81

    CAS  PubMed  Google Scholar 

  9. Bar-Oz B, Bulkowstein M, Benyamini L et al (2003) Use of antibiotic and analgesic drugs during lactation. Drug Saf 26:925–935

    Article  CAS  PubMed  Google Scholar 

  10. Barden J, Edwards JE, McQuay HJ, Moore RA (2004) Pain and analgesic response after third molar extraction and other postsurgical pain. Pain 107:86–90

    Article  PubMed  Google Scholar 

  11. Barr RG, Wentowski CC, Curhan GC et al (2004) Prospective study of acetaminophen use and newly diagnosed asthma among women. Am J Respir Crit Care Med 169:836–841

    Article  PubMed  Google Scholar 

  12. Beasley R, Clayton T, Crane J et al (2008) Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6–7 years: analysis from phase three of the ISAAC programme. Lancet 372:1039–1048

    Article  CAS  PubMed  Google Scholar 

  13. Bertolini A, Ferrari A, Ottani A et al (2006) Paracetamol: new vistas of an old drug. CNS Drug Rev 12:250–275

    Article  CAS  PubMed  Google Scholar 

  14. Bilenko N, Tessler H, Okbe R et al (2006) Determinants of antipyretic misuse in children up to 5 years of age: a cross-sectional survey. Clin Ther 28:783–793

    Article  CAS  PubMed  Google Scholar 

  15. Boyle M, Hundy S, Torda TA (1997) Paracetamol administration is associated with hypotension in the critically ill. Aust Crit Care 10:137–140

    Google Scholar 

  16. Breivik H, Collet B, Ventafridda V et al (2006) Survey of chronic pain in Europe: prevalence, impact on daily life and treatment. Eur J Pain 10:287–333

    Article  PubMed  Google Scholar 

  17. Buvanendran A, Kroin JS (2009) Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 22:588–593

    Article  PubMed  Google Scholar 

  18. Canbay A, Jochum C, Bechmann LP et al (2009) Acute liver failure in a Metropolitan area in Germany: a retrospective study (2002–2008). Z Gastroenterol 47:807–813

    Article  CAS  PubMed  Google Scholar 

  19. Chan AT, Manson JE, Albert CM et al (2006) Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events. Circulation 113:1578–1587

    Article  CAS  PubMed  Google Scholar 

  20. Chandrasekharan NV, Dai H, Roos KL et al (2002) COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proc Natl Acad Sci U S A 99:13926–13931

    Article  CAS  PubMed  Google Scholar 

  21. Chun LJ, Tong MJ, Busuttil RW, Hiatt JR (2009) Acetaminophen hepatotoxicity and acute liver failure. J Clin Gastroenterol 43:342–349

    Article  CAS  PubMed  Google Scholar 

  22. Curhan GC, Bullock AJ, Hankinson SE et al (2002) Frequency of use of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin in US women. Pharmacoepidemiol Drug Saf 11:687–693

    Article  CAS  PubMed  Google Scholar 

  23. Dart RC, Bailey E (2007) Does therapeutic use of acetaminophen cause acute liver failure? Pharmacotherapy 27:1219–1230

    Article  CAS  PubMed  Google Scholar 

  24. Maat MM de, Tijssen TA, Brüggemann RJ, Ponssen HH (2010) Paracetamol for intravenous use in medium- and intensive care patients: pharmacokinetics and tolerance. Eur J Clin Pharmacol 66:713–719

    Article  CAS  PubMed  Google Scholar 

  25. Hertog HM den, Worp HB van der, Gemert HM van et al (2009) The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol 8:434–440

    Article  Google Scholar 

  26. Dimova S, Hoet PH, Dinsdale D, Nemery B (2005) Acetaminophen decreases intracellular glutathione levels and modulates cytokine production in human alveolar macrophages and type II pneumocytes in vitro. Int J Biochem Cell Biol 37:1727–1737

    Article  CAS  PubMed  Google Scholar 

  27. Douglas L, Akil M (2006) Sodium in soluble paracetamol may be linked to raised blood pressure. BMJ 332:1133

    Article  PubMed  Google Scholar 

  28. Dubach UC, Rosner B, Sturmer T (1991) An epidemiologic study of abuse of analgesic drugs. Effects of phenacetin and salicylate on mortality and cardiovascular morbidity (1968 to 1987). N Engl J Med 324:155–160

    Article  CAS  PubMed  Google Scholar 

  29. Duggan ST, Scott LJ (2009) Intravenous paracetamol (acetaminophen). Drugs 69:101–113

    Article  CAS  PubMed  Google Scholar 

  30. Elia N, Lysakowski C, Tramer MR (2005) Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 103:1296–1304

    Article  CAS  PubMed  Google Scholar 

  31. Farquhar H, Crane J, Mitchell EA et al (2009) The acetaminophen and asthma hypothesis 10 years on: a case to answer. J Allergy Clin Immunol 124:649–651

    Article  PubMed  Google Scholar 

  32. Feldkamp ML, Meyer RE, Krikov S, Botto LD (2010) Acetaminophen use in pregnancy and risk of birth defects. Finding form the National Birth Defects Prevention Study. Obstet Gynecol 115:109–115

    Article  CAS  PubMed  Google Scholar 

  33. Fletcher D, Fermanian C, Mardaye A, Aegerter P (2008) A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 137:441–451

    Article  PubMed  Google Scholar 

  34. Forman JP, Stampfer MJ, Curhan GC (2005) Non-narcotic analgesic dose and risk of incident hypertension in US women. Hypertension 46:500–507

    Article  CAS  PubMed  Google Scholar 

  35. Fosnocht D, Taylor JR, Caravati EM (2008) Emergency department patient knowledge concerning acetaminophen (paracetamol) in over-the-counter and prescription analgesics. Emerg Med J 25:213–216

    Article  CAS  PubMed  Google Scholar 

  36. Giest J (2009) Paracetamol für die perioperative Schmerztherapie im Kindesalter – Ende einer Ära? Anasthesiol Intensivmed Notfallmed Schmerzther 50:57–59

    Google Scholar 

  37. Glintborg B, Andersen SE, Spang-Hanssen E, Dalhoff K (2004) The use of over-the-counter drugs among surgical and medical patients. Eur J Clin Pharmacol 60:431–437

    Article  PubMed  Google Scholar 

  38. Graham GG, Day RO, Graudins A, Mohamudally A (2010) FDA proposals to limit the hepatotoxicity of paracetamol (acetaminophen): are they reasonable? Inflammopharmacology 18:47–55

    Article  CAS  PubMed  Google Scholar 

  39. Graham GG, Scott KF (2005) Mechanism of action of paracetamol. Am J Ther 12:46–55

    Article  PubMed  Google Scholar 

  40. Gray A, Kehlet H, Bonnet F, Rawal N (2005) Predicting postoperative analgesia outcomes: NNT league tables or procedure-specific evidence? Br J Anaesth 94:710–714

    Article  CAS  PubMed  Google Scholar 

  41. Green K, Drvota V, Vesterqvist O (1989) Pronounced reduction of in vivo prostacyclin synthesis in humans by acetaminophen (paracetamol). Prostaglandins 37:311–315

    Article  CAS  PubMed  Google Scholar 

  42. Hammarqvist F, Luo JL, Cotgreave IA et al (1997) Skeletal muscle glutathione is depleted in critically ill patients. Crit Care Med 25:78–84

    Article  CAS  PubMed  Google Scholar 

  43. Heard K, Sloss D, Weber S, Cart RC (2006) Overuse of over-the-counter analgesics by emergency department patients. Ann Emerg Med 48:315–318

    Article  PubMed  Google Scholar 

  44. Heard KJ (2008) Acetylcysteine for Acetaminophen poisoning. N Engl J Med 359:285–292

    Article  CAS  PubMed  Google Scholar 

  45. Hersch M, Raveh D, Izbicki G (2008) Effect of intravenous propacetamol on blood pressure in febrile critically ill patients. Pharmacotherapy 28:1205–1210

    Article  CAS  PubMed  Google Scholar 

  46. Hinson JA, Roberts DW, James LP (2010) Mechanisms of acetaminophen-induced liver necrosis. Handb Exp Pharmacol 196:369–405

    Article  CAS  PubMed  Google Scholar 

  47. Hinz B, Cheremina O, Brune K (2008) Acetaminophen (paracetamol) is a selective cyclooxygenase-2 inhibitor in man. FASEB J 22:383–390

    Article  CAS  PubMed  Google Scholar 

  48. Pettersson PH, Jakobsson J, Owall A (2005) Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 19:306–309

    Article  CAS  PubMed  Google Scholar 

  49. Holmer Pettersson P, Jakobsson J, Owall A (2006) Plasma concentrations following repeated rectal or intravenous administration of paracetamol after heart surgery. Acta Anaesthesiol Scand 50:673–677

    Article  Google Scholar 

  50. Holmer Pettersson P, Owall A, Jakobsson J (2004) Early bioavailability of paracetamol after oral or intravenous administration. Acta Anaesthesiol Scand 48:867–870

    Article  Google Scholar 

  51. Information P (2009) Perfalgan 10 mg/ml, solution for infusion. Bristol-Meyers Squibb, New York

  52. Jarde O, Boccard E (1997) Parenteral versus oral route increases paracetamol efficacy. Clin Drug Invest 14:474–481

    Article  Google Scholar 

  53. Jarrett DR (2008) Paracetamol and hypertension: time to label sodium in drug treatments? BMJ 336:1324

    Article  PubMed  Google Scholar 

  54. Kis B, Snipes JA, Busija DW (2005) Acetaminophen and the cyclooxygenase-3 puzzle: sorting out facts, fictions, and uncertainties. J Pharmacol Exp Ther 315:1–7

    Article  CAS  PubMed  Google Scholar 

  55. Koren G, Cairns J, Chitayat D et al (2006) Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother. Lancet 368:704

    Article  PubMed  Google Scholar 

  56. Kotzampassi K, Kolios G, Manousou P et al (2009) Oxidative stress due to anesthesia and surgical trauma: importance of early enteral nutrition. Mol Nutr Food Res 53:770–779

    Article  CAS  PubMed  Google Scholar 

  57. Kumpulainen E, Kokki H, Halonen T et al (2007) Paracetamol (acetaminophen) penetrates readily into the cerebrospinal fluid of children after intravenous administration. Pediatrics 119:766–771

    Article  PubMed  Google Scholar 

  58. Larson AM (2007) Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol 40:3–20

    Google Scholar 

  59. Larson AM, Polson J, Fontana RJ et al (2005) Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 42:1364–1372

    Article  CAS  PubMed  Google Scholar 

  60. Launiainen T, Sajantila A, Rasanen I et al (2010) Adverse interaction of warfarin and paracetamol: evidence from a post-mortem study. Eur J Clin Pharmacol 66:97–103

    Article  CAS  PubMed  Google Scholar 

  61. Lauterburg BH (2002) Analgesics and glutathione. Am J Ther 9:225–233

    Article  PubMed  Google Scholar 

  62. Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (2007) S3-Leitlinie: Behandlung akuter perioperativer und posttraumatischer Schmerzen. AWMF 041/001. http://www.uni-duesseldorf.de/AWMF/ll/041-001.pdf. Gesehen 16 Jul 2010

  63. Lonnqvist PA, Morton NS (2005) Postoperative analgesia in infants and children. Br J Anaesth 95:59–68

    Article  PubMed  Google Scholar 

  64. Luo JL, Hammarqvist F, Andersson K, Wernerman J (1996) Skeletal muscle glutathione after surgical trauma. Ann Surg 223:420–427

    Article  CAS  PubMed  Google Scholar 

  65. Mackenzie I, Forrest K, Thompson F, Marsh R (2000) Effects of acetaminophen administration to patients in intensive care. Intensive Care Med 26:1408

    Article  CAS  PubMed  Google Scholar 

  66. Mahe I, Bertrand N, Drouet L et al (2006) Interaction between paracetamol and warfarin in patients: a double-blind, placebo-controlled, randomized study. Haematologica 91:1621–1627

    CAS  PubMed  Google Scholar 

  67. Mahe I, Bertrand N, Drouet L et al (2005) Paracetamol: a haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 59:371–374

    Article  CAS  PubMed  Google Scholar 

  68. Mattia A, Coluzzi F (2009) What anesthesiologists should know about paracetamol (acetaminophen). Minerva Anestesiol 75:644–653

    CAS  PubMed  Google Scholar 

  69. McDaid C, Maund E, Rice S et al (2010) Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess 14:1–153, iii–iv

    CAS  PubMed  Google Scholar 

  70. Merry AF, Gibbs RD, Edwards J et al (2010) Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial. Br J Anaesth 104:80–88

    Article  CAS  PubMed  Google Scholar 

  71. Michna E, Duh MS, Korves C, Dahl JL (2010) Removal of opioid/acetaminophen combination prescription pain medications: assessing the evidence for hepatotoxicity and consequences of removal of these medications. Pain Med 11:369–378

    Article  PubMed  Google Scholar 

  72. Moller PL, Sindet-Pedersen S, Petersen CT et al (2005) Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth 94:642–648

    Article  CAS  PubMed  Google Scholar 

  73. Morgan O, Hawkins L, Edwards N, Dargan P (2007) Paracetamol (acetaminophen) pack size restrictions and poisoning severity: time trends enquiries to a UK poisons centre. J Clin Pharm Ther 32:449–455

    Article  CAS  PubMed  Google Scholar 

  74. Murray KF, Hadzic N, Wirth S et al (2008) Drug related hepatotoxicity and acute liver failure. J Pediatr Gastroenterol Nutr 47:395–405

    Article  CAS  PubMed  Google Scholar 

  75. Newson RB, Shaheen SO, Chinn S, Burney PG (2000) Paracetamol sales and atopic disease in children and adults: an ecological analysis. Eur Respir J 16:817–823

    Article  CAS  PubMed  Google Scholar 

  76. Ong CKS, Seymour RA, Lirk P, Merry AF (2010) Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a quantitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 110:1170–1179

    CAS  PubMed  Google Scholar 

  77. Osborne ZP, Bryant SM (2003) Patients discharged with a prescription for acetaminophen-containing narcotic analgesics do not receive appropriate written instructions. Am J Emerg Med 21:48–50

    Article  PubMed  Google Scholar 

  78. Pickering G, Loriot MA, Libert F et al (2006) Analgesic effect of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clin Pharmacol Ther 79:371–378

    Article  CAS  PubMed  Google Scholar 

  79. Rebordosa C, Kogevinas M, Bech BH et al (2009) Use of acetaminophen during pregnancy and risk of adverse pregnancy outcomes. Int J Epidemiol 38:706–714

    Article  PubMed  Google Scholar 

  80. Remy C, Marret E, Bonnet F (2005) Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth 94:505–513

    Article  CAS  PubMed  Google Scholar 

  81. Riordan SM, Williams R (2002) Alcohol exposure and paracetamol-induced hepatotoxicity. Addict Biol 7:191–206

    Article  CAS  PubMed  Google Scholar 

  82. Ritter JM, Harding I, Warren JB (2009) Precaution, cyclooxygenase inhibition, and cardiovascular risk. Trends Pharmacol Sci 30:503–508

    Article  CAS  PubMed  Google Scholar 

  83. Shaheen S, Potts J, Gnatiuc L et al (2008) The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 32:1231–1236

    Article  CAS  PubMed  Google Scholar 

  84. Shaheen SO, Newson RB, Smith GD, Henderson AJ (2010) Prenatal paracetamol exposure and asthma: further evidence against confounding. Int J Epidemiol

  85. Shaheen SO, Sterne JA, Songhurst CE, Burney PG (2000) Frequent paracetamol use and asthma in adults. Thorax 55:266–270

    Article  CAS  PubMed  Google Scholar 

  86. Spigset O, Hagg S (2000) Analgesics and breast feeding: safety considerations. Paediatr Drugs 2:223–238

    Article  CAS  PubMed  Google Scholar 

  87. Stamer UM, Zhang L, Stüber F (2010) Personalized therapy in pain management: where do we stand? Pharmacogenomics 11:843–864

    Article  CAS  PubMed  Google Scholar 

  88. Temple AR, Lynch JM, Vena J et al (2007) Aminotransferase activities in healthy subjects receiving three-day dosing of 4, 6, or 8 grams per day of acetaminophen. Clin Toxicol (Phila) 45:36–44

    Google Scholar 

  89. Thomsen SF, Kyvik KO, Skadhauge L et al (2008) Intake of paracetamol and risk of asthma in adults. J Asthma 45:675–676

    Article  CAS  PubMed  Google Scholar 

  90. Toms L, Derry S, Moore RA, McQuay HJ (2009) Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev: CD001547

    Google Scholar 

  91. Toms L, McQuay HJ, Derry S, Moore RA (2008) Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev: CD004602

    Google Scholar 

  92. Trzortzopoulou A, McNicol ED, Cepeda MS et al (o J) Singel dose porpacetamol or iv paracetamol for postoperative pain. Cochrane Database Syst Rev Intervention Protocol

  93. Ubeda A, Llopico J, Sanchez MT (2009) Blood pressure reduction in hypertensive patients after withdrawal of effervescent medication. Pharmacoepidemiol Drug Saf 18:417–419

    Article  PubMed  Google Scholar 

  94. Marel CD van der, Anderson BJ, Pluim MA et al (2003) Acetaminophen in cerebrospinal fluid in children. Eur J Clin Pharmacol 59:297–302

    Article  PubMed  Google Scholar 

  95. Marel CD van der, Peters JW, Bouwmeester NJ et al (2007) Rectal acetaminophen does not reduce morphine consumption after major surgery in young infants. Br J Anaesth 98:372–379

    Article  PubMed  Google Scholar 

  96. Voronov P, Przybylo HJ, Jagannathan N (2007) Apnea in a child after oral codeine: a genetic variant – an ultra-rapid metabolizer. Paediatr Anaesth 17:684–687

    Article  PubMed  Google Scholar 

  97. Watkins PB, Kaplowitz N, Slattery JT et al (2006) Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial. JAMA 296:87–93

    Article  CAS  PubMed  Google Scholar 

  98. Westman B, Thörne A, Rooyackers O et al (2009) Glutathione and amino acid concentrations in human liver during short warm ischaemia and reperfusion: a pilot study. Clin Sci (Lond) 117:339–344

    Google Scholar 

  99. Westman B, Weidenhielm L, Rooyackers O et al (2007) Knee replacement surgery as a human clinical model of the effects of ischaemia/reperfusion upon skeletal muscle. Clin Sci (Lond) 113:313–318

    Google Scholar 

  100. Woodcock J (2009) A difficult balance – pain management, drug safety, and the FDA. N Engl J Med 361:2105–2107

    Article  CAS  PubMed  Google Scholar 

  101. Zyoud SH, Awang R, Sulaiman SAS, Al-Jabi SW (2010) Association between gastrointestinal manifestations following acetaminophen poisoning and outcome in 291 acetaminophen poisoning patients. Pharmacoepidemiol Drug Saf 19:511–517

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48129, Münster, Deutschland

    P.K. Zahn &  E.M. Pogatzki-Zahn

  2. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie & UniversitätsSchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

    R. Sabatowski

  3. School of Medicine and Pharmacology, University of Western Australia, -, Australia

    S.A. Schug

  4. Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia

    S.A. Schug

  5. Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Universitätspital Bern, Bern, Schweiz

    U.M. Stamer

Authors
  1. P.K. Zahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Sabatowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S.A. Schug
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U.M. Stamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E.M. Pogatzki-Zahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E.M. Pogatzki-Zahn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zahn, P., Sabatowski, R., Schug, S. et al. Paracetamol für die perioperative Analgesie. Anaesthesist 59, 940–952 (2010). https://doi.org/10.1007/s00101-010-1773-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-010-1773-z

Schlüsselwörter

Keywords

Search

Navigation