Acetaminophen Does Not Reduce Postoperative Opiate Consumption in Patients Undergoing Craniotomy for Cerebral Revascularization: A Randomized Control Trial

Abstract

BackgroundPostoperative management in patients undergoing craniotomy is unique and challenging. We utilized a population of patients who underwent bilateral extracranial-to-intracranial (EC-IC bypass) revascularization procedures for moyamoya disease and hypothesized that 1 gram (gm) of intravenous (IV) acetaminophen given immediately after intubation and again 45 minutes prior to the end of craniotomy may be more effective than saline in minimizing opiate consumption and decreasing pain scores.MethodsIn a double-blind, randomized, placebo-controlled crossover pilot study, 40 craniotomies in 20 patients were studied. A random number generator assigned patients to receive either 1 gram of IV acetaminophen or an equal volume of normal saline immediately after intubation and again 45 minutes prior to the end of their first operation. For the second surgery, patients received the study drug (IV acetaminophen or normal saline) that they did not receive during their first surgery.ResultsIn the IV acetaminophen group, the average 24-hour postoperative fentanyl equivalent consumption was decreased but the difference was not statistically significant: 228 micrograms compared to 312 micrograms in the placebo group (Figure 1; p = 0.09). Pain scores did not significantly differ between the IV acetaminophen group and the placebo group in postoperative hours 0-12 (Figure 2; p = 0.44) or 24 (Figure 3; p = 0.77).ConclusionOur study demonstrates that in patients receiving bilateral craniotomies for moyamoya disease, IV acetaminophen when given immediately after intubation and again 45 minutes prior to closure does not significantly decrease 12- or 24-hour postoperative opiate consumption.

Diclofenac Is Superior to Paracetamol in Postoperative Pain Scores and Analgesic Consumption in Supratentorial Craniotomy With No Difference in Platelet and Clot Function: A Prospective Randomized Controlled Trial

“…Artime et al13 reported no reduction in opioid requirement in patients who received scheduled IV paracetamol for postcraniotomy pain in the first 24 hours after surgery; however, overall patient satisfaction scores was better with the use of paracetamol as compared with placebo. Similarly, in a randomized placebo-controlled crossover pilot study in which patients received IV paracetamol after intubation and 45 minutes before skin closure during craniotomy for moyamoya disease, Burbridge et al14 found no significant difference in postoperative fentanyl consumption and visual analog scale scores at 0 to 12 hours or at 24 hours postoperatively.…”

Pain management after elective craniotomy

“…[11][12][13]15 In one study, paracetamol was only used intra-operatively, showing no difference in postoperative pain scores. 14 Pain management after elective craniotomy 749 Eur J Anaesthesiol 2023; 40:747-757…”

Machine learning approach to predict postoperative opioid requirements in ambulatory surgery patients

“…Towards this, previous studies have retrospectively looked for predictors of postoperative pain and analgesic consumption, identifying four significant predictors including age, type of surgery, anxiety levels, and psychological distress [8]. Some of these studies have focused on specific types of surgeries and patient population to determine factors associated with postoperative opioid usage [9,10]. To date, a review of the published literature indicates the lack of rigorous research pertaining to the identification of perioperative predictive factors for acute postoperative pain and opioid requirements across a wide spectrum of surgeries.…”