Paracetamol IV (Orthopaedic — Opioid-Sparing)

How it works

Its analgesic and antipyretic action is thought to be mediated centrally, including effects on prostaglandin pathways, with little peripheral anti-inflammatory activity.

Prescribing in practice

• Dose by body weight and reduce in low-weight adults, hepatic impairment, malnutrition or chronic alcohol use to avoid hepatotoxicity, taking care to avoid duplicate paracetamol from other sources.
• Administer as a slow infusion and check no other paracetamol-containing products are being given concurrently.
• Used as the analgesic foundation, it reduces opioid requirements and associated adverse effects after orthopaedic surgery.

Monitoring

Monitor pain scores and cumulative paracetamol intake from all routes, with liver function review if overdose is suspected.

Counselling the patient

• This is a regular background painkiller used to reduce the amount of strong opioid needed.
• Tell the team about any paracetamol-containing tablets you take so doses are not duplicated.
• Report ongoing pain so additional analgesia can be added.

Evidence & guidelines

Paracetamol is recommended as the foundation of multimodal, opioid-sparing analgesia in UK enhanced-recovery and perioperative guidance.