Paracetamol IV (Burns Multimodal Analgesia)

How it works

It produces central analgesic and antipyretic effects through poorly defined central mechanisms including modulation of prostaglandin pathways; the intravenous route bypasses variable gastrointestinal absorption.

Prescribing in practice

• Dose by body weight and reduce in low-weight adults, hepatic impairment, malnutrition or sepsis because of the risk of hepatotoxicity, and account for all paracetamol sources to avoid inadvertent overdose; intravenous dosing errors are a recognised hazard.
• It is opioid-sparing and reduces procedural and background opioid requirements when used as scheduled baseline analgesia.
• Confirm there is no other paracetamol-containing medication being given concurrently before prescribing the intravenous form.

Monitoring

Monitor analgesic effect and cumulative paracetamol intake from all routes, with attention to hepatic risk factors in catabolic burns patients.

Counselling the patient

• This is a regular non-opioid painkiller that lowers the need for stronger drugs.
• Team: account for all paracetamol sources and reduce the dose in low body weight or liver risk.
• Report any other paracetamol-containing products you may have taken.

Evidence & guidelines

Paracetamol as the basis of multimodal, opioid-sparing analgesia is supported by perioperative and burns analgesia guidance.