Summary of findings 4. Acetaminophen compared with control or placebo medications for prevention of pain in adults undergoing brain surgery.
| Acetaminophen compared with control or placebo medications for prevention of pain in adults undergoing brain surgery | ||||||
|
Patient or population: adults undergoing brain surgery Settings: hospitals, countries: Turkey, India, United States of America Intervention: acetaminophen Comparison: control or placebo medication | ||||||
| Outcomes | Absolute Effects (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed Risk | Corresponding Risk | |||||
|
Acute postoperative pain 0 to 6 hours |
The mean pain scores in the control group ranged from 1.5 to 5,6 | Mean difference in pain intensity was 0.35 points lower in those who received acetaminophen when compared to those who received control or placebo medication (1.00 points lower to 0.30 points higher) | Not applicable | 332 (3) |
⊕⊕⊕⊝ moderate1 |
|
| Acute postoperative pain at 12 hours | The mean pain scores in the control group ranged from 2.0 to 5.8 | Mean difference in pain intensity was 0.51 points lower in those who received acetaminophen when compared to those who received control or placebo medication (1.04 points lower to 0.03 points higher) | Not applicable | 332 (3) |
⊕⊕⊕⊝ moderate 1 |
|
| Acute postoperative pain at 24 hours | The mean pain scores in the control group ranged from 1.16 to 5.4 | Mean difference in pain intensity was 0.34 points lower in those who received acetaminophen when compared with those who received control or placebo medication (1.20 points lower to 0.52 points higher) | Not applicable | 459 (4) |
⊕⊕⊕⊕ high | |
| Acute postoperative pain at 48 hours | The mean pain scores in the control group was 5.5 | The mean pain scores in the control group was 5.5, with no significant difference between the groups | Not applicable | 202 (1) |
⊕⊝⊝⊝ very low2 | Only 1 study reported this outcome |
|
Additional analgesia requirements 0 to 24 hours (milligrams) |
Mean additional analgesia requirement in the control group ranged from 1.75 mg to 85.5 mg | Mean difference in additional analgesia requirements in the first 24 hours after surgery 0.07 mg less in those who received acetaminophen when compared with those who received control or placebo medication (0.86 mg less to 0.99 mg more) | Not applicable | 459 (4) |
⊕⊕⊕⊕ high | |
| Analgesic Success | Not calculated | Not calculated | Not applicable | Not applicable | Not applicable | No eligible study addressed this outcome |
|
Sedation score at 24 hours (Richmond Agitation Sedation scale) |
Mean sedation score in the control group was zero | Mean sedation score in the acetaminophen group was zero | Not applicable | 131 (1) |
⊕⊝⊝⊝ very low2 | Only 1 study reported this outcome |
| Chronic headache | Not calculated | Not calculated | Not applicable | Not applicable | Not applicable | No eligible study addressed this outcome |
| Length of critical care stay (hours) | The median length of stay in the control group was 28 hours | The median length of stay in the acetaminophen group was 26 hours | Not applicable | 131 (1) |
⊕⊝⊝⊝ very low2 | Only 1 study reported this outcome |
| Length of hospital stay (hours) | Mean length of stay in hospital in the control group ranged from 75.5 to 137 days | Mean difference in length of stay in hospital of 3.71 hours less in those who received acetaminophen when compared with those who received control or placebo medication (14.12 hours less to 6.7 hours more) | Not applicable | 335 (2) |
⊕⊕⊕⊝ moderate1 |
|
| Adverse events | Not calculated | Not calculated | Not calculated | Not applicable | Not applicable | No two studies reported comparable adverse events |
| CI: Confidence interval; RR: Risk Ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
- The evidence was downgraded by one level due to a small pooled sample size.
- The evidence was downgraded three levels due to the fact that all the evidence came from one small study.