Adverse effect profile comparison of pain regimens with and without intravenous acetaminophen in total hip and knee arthroplasty patients

Abstract

Background:The use of adjunct, non-opioid agents is integral for pain control following total hip and knee arthroplasty. Literature comparing safety profiles of intravenous acetaminophen versus opioids is lacking.Objective:To determine whether there is a difference in frequency and type of adverse effects between intravenous acetaminophen–treated and non-intravenous acetaminophen–treated patients. Primary safety endpoints included any adverse effect noted in the electronic medical record post-surgically. Secondary endpoints included changes in laboratory values, vital signs, and pain scores.Methods:This is a retrospective, matched, cohort study with data collected from electronic medical records. Adverse effects were collected from progress notes, nursing notes, and post-operative notes. Mean pain score was measured by the 11-point visual analog scale over a 72-h period.Results:A total of 609 patients who underwent a total hip or knee replacement were included. In all, 406 patients were treated with intravenous acetaminophen, and 203 patients received medication management without intravenous acetaminophen. More patients treated with intravenous acetaminophen experienced an adverse effect compared to patients who did not receive intravenous acetaminophen (91.63% versus 84.73%; p = 0.012). Mean cumulative acetaminophen exposure was similar in the intravenous acetaminophen group (7704.89 ± 2558.6 versus 7260.1 ± 3016.09 mg; p = 0.07). Mean opioid use was similar in the intravenous acetaminophen group as compared to the non-intravenous acetaminophen group (209.61 ± 555.09 versus 163.89 ± 232.44 mg; p = 0.152). Significantly higher mean pain scores were found in the intravenous acetaminophen group during the 72-h post-surgery period as compared with non-intravenous acetaminophen-treated patients.Conclusion:The increased utilization of intravenous acetaminophen in multimodal pain management did not result in an improved safety or tolerability profile or reduced opioid utilization in orthopedic patients.

The efficiency of intravenous acetaminophen for pain control following total knee and hip arthroplasty

“…In the primary search, 228 articles were reviewed. Finally, 3 RCTs [ 12 – 14 ] and 1 non-RCTs [ 15 ] met eligibility criteria of the present meta-analysis. Overall, the 4 studies included 534 patients in the acetaminophen groups and 331 patients in the control groups.…”

A Feasibility Study of Percutaneous Peripheral Nerve Stimulation for the Treatment of Postoperative Pain Following Total Knee Arthroplasty

“…Previous studies on outcomes following TKA using traditional approaches to postoperative analgesia have reported extended opioid use and delayed functional recovery. In recent studies of patients receiving various postoperative treatments (e.g., oral medications, local anesthetic-based nerve blocks, transcutaneous electrical nerve stimulation, intravenous acetaminophen), average opioid consumption is often greatest during the immediate postoperative period (e.g., average daily morphine equivalent dosage [MED] of approximately 30-170 mg during postoperative days 0-3) (7,(39)(40)(41)(42)(43); fewer than 30% of patients had ceased opioid use by four weeks following TKA, and the median time to opioid cessation was approximately 45-60 days (4,6,7). In the present study, average daily MED during postoperative days 0-3 was approximately 22 mg, a majority (4 of 7; 57%) of subjects reported opioid cessation within the first week following surgery, and the median time to opioid cessation was six days.…”

Evolution of an Opioid Sparse Pain Management Program for Total Knee Arthroplasty With the Addition of Intravenous Acetaminophen

“…Of particular benefit, Singla et al [12] demonstrated that patients receiving IV acetaminophen consumed less than half the rescue opioids than those receiving placebo following total hip arthroplasty. However, in a retrospective chart review, Gallipani et al [24] did not appreciate a decrease in narcotic use in patients given IV acetaminophen following total joint arthroplasty. Other studies by Kelly et al [25] and Nwagbologu et al [26] did not find a decrease in opioid consumption in patients who received IV acetaminophen following TKA.…”

“…Despite these conflicting studies, a prospective, randomized trial [21] and retrospective database study [9] have demonstrated that patients receiving IV acetaminophen had fewer adverse events after total joint arthroplasty. However, Gallipani et al [24] in a retrospective chart review demonstrated an increase in adverse events in patients given IV acetaminophen following total joint arthroplasty. These studies vary in their conclusions, and it is incumbent upon the treating surgeon to be aware of these conflicting reports on the utility of IV acetaminophen in the literature.…”