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December 20, 2013 06:45

Paracetamol IV, sudah di setujui penggunaannya sebagai tatalaksana nyeri derajat ringan-sedang, terapi tambahan bersamaan dengan opioid pada nyeri derajat berat dan untuk terapi demam. Produk ini dikemas dalam bentuk vial kaca berisi larutan 100 mL dengan dosis paracetamol 10 mg/mL yang diberikan dengan cara infus intravena selama 15 menit. Salah satu alasan pemberian selama 15 menit (dan tidak lebih cepat) adalah berdasarkan dari pengalaman penggunaan prodrug paracetamol sebelumnya, yaitu propacetamol yang menimbulkan nyeri pada tempat suntikan ketika diberikan dengan kecepatan infus yang cepat.

Perbedaan propacetamol IV dan paracetamol IV adalah bentuk sediaannya dimana propacetamol dikemas dalam bentuk serbuk kering yang perlu direkonstitusi sebelum diberikan dan memiliki pH 3,5-4 dengan osmolaritas 410 mOsm/L, sedangkan paracetamol atau acetaminophen lebih isotonik dengan pH 5,5 dan osmolaritas 290 mOsm/L, sehingga larutan paracetamol lebih menyerupai osmolaritas plasma dengan pH yang tidak terlalu asam jika dibandingkan dengan propacetamol.

Pada sebuah penelitian disebutkan bahwa kejadian nyeri pada tempat injeksi secara bermakna lebih rendah pada kelompok paracetamol jika dibandingkan dengan kelompok propacetamol (p<0,001) dengan cara pemberian yang sama. Sebuah penelitian terbaru dilakukan untuk mengevaluasi keamanan dari pemberian infus paracetamol IV secara cepat (<15 menit). Studi dilakukan terhadap 100 pasien tanpa penyakit hati atau gangguan fungsi hati yang membutuhkan analgesik paracetamol dimasukkan dalam studi ini. Pasien diberikan 100 mL paracetamol infus yang diberikan dengan cara infus intravena free-flowing (clamps infus dibiarkan terbuka – tidak diperhitungkan kecepatan tetesan infus). Pasien dimonitor setiap 2 menit dan kecepatan infus dapat disesuaikan atas permintaan pasien.

Berikut ini adalah hasil dari studi tersebut: lama infus rerata adalah 3 menit dan 45 detik. Tidak dilaporkan terjadinya eritema (kemerahan) pada tepat suntikan. Hanya 1 pasien yang merasakan nyeri ringan pada tempat suntikan, dan hanya berlangsung selama kurang lebih 10 detik. Terjadi perubahan parameter tekanan darah, seperti sistolik, diastolik dan MAP (mean arterial pressure) jika dibandingkan dengan basa (p<0,0001), akan tetapi perubahan parameter tidak bermakna secara klinis. Tidak dilaporkan efek samping selama proses pemberian infus dan 5 menit pascainfus yang dievaluasi oleh dokter anestesi.

Kesimpulan: Pemberian paracetamol IV secara infus intravena selama 3 menit 45 detik (waktu rerata) aman dan tidak dilaporkan adanya efek samping yang disebabkan oleh pemberian infus paracetamol secara cepat. Pemberian infus paracetamol cepat dapat memberikan keuntungan seperti pencapaian Tmax yang cepat untuk kontrol nyeri yang lebih baik.(MAJ)




Image: Ilustrasi
Referensi :
1.Moller PL, Juhl GI, Payen-Champenois C, Skoglund LA. Intravenous acetaminophen (paracetamol): comparable analgesic efficacy, but better local safety than its prodrug, propacetamol, for postoperative pain after third molar surgery. Anesth Analg. 2005;101(1):90-6.
2.Jones VM. Acetaminophen injection: a review of clinical information. J Pain Palliat Care Pharmacother. 2011;25(4):340-9.
3.Needleman SM. Safety of rapid intravenous of infusion acetaminophen. Proc (Bayl Univ Med Cent). 2013;26(3):235-8.

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