STUDY OBJECTIVE To examine the impact of intravenous acetaminophen on the total quantity of opioids (in morphine equivalents) administered within the first 48 hours postoperatively and perioperatively, while still affording patients adequate analgesia, in women who underwent total abdominal hysterectomies. DESIGN Retrospective chart review. SETTING Tertiary care community hospital. PATIENTS One hundred women underwent total abdominal hysterectomies performed by a single surgeon: 50 patients received opioids only (fentanyl, morphine, hydromorphone, meperidine, or oxycodone), without the addition of any acetaminophen, between January 1 and March 28, 2011, and 50 patients received intravenous acetaminophen 1000 mg every 6 hours in addition to opioids (multimodal group) between May 1 and July 16, 2012 (time period coincided with the addition of intravenous acetaminophen to the hospital formulary). Patients in both groups were also given nonopioids (celecoxib, dexmedetomidine, aspirin, or tizanidine) perioperatively. MEASUREMENTS AND MAIN RESULTS Patients in both groups had a mean age of 55 years (mean AE SD 55 AE 13 yrs in the multimodal group, 55 AE 15 yrs in the opioids-only group), surgery time of 2 hours (116 AE 51 min in the multimodal group, 118 AE 40 min in the opioids-only group), and an anesthesia time of~3.5 hours (209 AE 79 min in the multimodal group, 207 AE 79 min in the opioids-only group). During postoperative days 1-2, intravenous acetaminophen reduced opioid use by 31% (mean AE SD 47 AE 24 mg in the multimodal group vs 68 AE 37 mg in the opioids-only group, p=0.003) and by 26% during the total perioperative period, defined as preoperative, intraoperative, recovery room, and postoperative days 1-2 (73 AE 24 mg in the multimodal group vs 99 AE 39 mg in the opioids-only group, p=0.001). CONCLUSION The multimodal approach to perioperative analgesic management, which includes concurrent administration of intravenous acetaminophen and opioids, is effective in reducing the total average amount of opioids administered on postoperative days 1-2 and perioperatively. Limitations of this study include its short duration, retrospective design, and single-site setting. These results may not be generalized to patients undergoing other types of obstetric-gynecologic surgeries. KEY WORDS acetaminophen, Ofirmev, opioids, hysterectomy, postoperative, perioperative.
