Effect of Intravenous Acetaminophen on Postoperative Opioid Consumption in Adult Orthopedic Surgery Patients

Abstract

: Postoperative pain is managed with opioids, which are associated with adverse effects. The efficacy of intravenous (IV) acetaminophen in reducing opioid consumption has been studied with inconsistent results. The primary outcome of this study was to assess the effect of IV acetaminophen on opioid consumption 24 hours postoperatively. Secondary outcomes included the opiate consumption at 48 hours after the operation, opioid-related side effects 72 hours after the operation, discharge disposition, and length of stay. This was an IRB-approved, retrospective cohort study including adult patients who underwent an elective total knee arthroplasty (TKA). Patients were stratified into IV and no IV acetaminophen groups; patients who had received at least one dose of IV acetaminophen were included in the IV acetaminophen group. Total opioids were collected, converted to morphine equivalents, and compared between groups. Patients were excluded for alcohol abuse, substance abuse treatment, non-elective TKA, or medication mischarting.: Of the 161 patients evaluated, 148 patients were included: 86 in the IV acetaminophen and 62 in the no IV acetaminophen group. There were no differences in mean morphine equivalents between groups postoperatively at 24 hours (54.2 ± 35.9 mg vs 45.4 ± 30.2 mg; = .12) and 48 hours (99.2 ± 68.7 mg vs 79.5 ± 49.1 mg; = .06). There were no differences in secondary outcomes (administration of bowel regimen medications, antiemetics, naloxone, discharge disposition, or length of stay) between the groups. : The use of IV acetaminophen was not associated with a decrease in opiate use, opiate-related side effects, or any secondary outcomes in patients who underwent TKA.

Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis

“…Kelly et al [ 15 ] drew the conclusion that IV acetaminophen did not significantly decrease postoperative opioid use in patients who underwent surgical knee procedures. Studies conducted by Blank et al [ 16 ] and Nwagbologu et al [ 17 ] presented similar conclusions. However, O’Neal et al [ 18 ] reported that neither IV nor oral acetaminophen provided better analgesia in patients undergoing TKA.…”

“…Finally, 6 studies [ 15 , 17 – 19 , 21 , 23 ] were included in our meta-analysis after full-text reading. Among them, there were 2 RCTs [ 18 , 19 ] and 4 RCSs [ 15 , 17 , 21 , 23 ]. General characteristics of the included RCTs can be seen in Table 1 .…”

“…Several studies have reported that IV acetaminophen has a beneficial role in reducing pain intensity and morphine consumption after TKA [ 19 , 20 ]. However, some other studies suggest that the use of acetaminophen in multimodal pain management does not result in improved safety or reduced opioid utilization in hip or knee arthroplasty [ 17 , 21 ].…”

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

“…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.…”

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

“…In another study, Nwagbologu et al reported on 148 patients who underwent TKA, of which 86 received IV APAP and 62 who did not receive any, and found that there were no significant differences in terms of LOS (3.7 vs. 3.9; p ¼ 0.27) or discharge disposition (71 vs. 76% of patients discharged home; p ¼ 0.51). 22 However, these studies had a small number of patients, which may have not been sufficient to reach statistical significance.…”