Comparison of Intraoperative Opioid Consumption in Elective Cranial Surgery Patients with and without Preemptive Oral Paracetamol: A Propensity Score Matching Analysis
Abstract
Objective: Cranial surgery is associated with significant postoperative pain. Opioids are commonly used to provide pain relief. However, their use can lead to unwanted consequences, including neurological deterioration and respiratory depression. This study aimed to assess the benefits of preemptive oral paracetamol on intraoperative opioid consumption in patients undergoing elective cranial surgery.
Material and Methods: This retrospective propensity score-matched cohort study analyzed data from 336 patients who underwent elective cranial surgery. Patients receiving preemptive oral paracetamol were matched with those not receiving preemptive oral paracetamol using propensity scoring (nearest neighbor matching without replacement) with a caliper distance of 0.2 in a ratio of 1:2. Regression models were used to analyze the association between preemptive oral paracetamol, intraoperative opioid consumption, and hemodynamic changes at intubation.
Results: Among 336 patients, 193 were matched for analysis (78 with and 115 without preemptive oral paracetamol). For the primary outcome, patients receiving preemptive oral paracetamol required significantly less intraoperative fentanyl (-5.1 mcg/hours, 95% CI -0.8 to -9.3; p-value=0.02). There were no significant differences in hemodynamics during intubation between groups.
Conclusion: Preemptive oral paracetamol led to a statistically significant, but not clinically meaningful, reduction of intraoperative fentanyl consumption. These findings should be interpreted with caution regarding potential changes in practice.
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