Efficacy of Intravenous Acetaminophen for Postoperative Analgesia in Primary Total Knee Arthroplasty

Huang, Philip; Gleason, Scott M.; Shah, Jalaal A.; Buros, Amy; Hoffman, David A.

doi:10.1016/j.arth.2017.10.054

Cited by 21 publications

(18 citation statements)

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“…One randomized, doubleblinded trial showed that patients receiving IV acetaminophen following TKA had better pain relief [11]. In another prospective study, Gupta et al [21] showed that IV acetaminophen significantly reduced patients' pain scores, a finding confirmed by multiple other authors [10,13]. In particular, administering IV acetaminophen intraoperatively may reduce pain in the immediate postoperative period [22].…”

Section: Discussionmentioning

confidence: 93%

“…This may suggest that the intraoperative dose of IV acetaminophen may be the more effective intervention, and the second administration of the IV acetaminophen at 6 hours postoperatively may not be as effective in preventing rescue narcotics as anesthesia and short-acting periarticular blocks wear off as well as PT being initiated. Recent studies of TJA patients receiving IV acetaminophen have demonstrated a reduced LOS, fewer adverse events [9], lower pain scores [10,11] and opioid requirements [11], and a decreased need for rescue opioids [12]. However, 2 recent meta-analyses have shown mixed results, citing limited quality evidence supporting the use of IV acetaminophen and the need for future randomized controlled trials [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Gupta et al [21] performed a prospective study on use of IV acetaminophen with IV ibuprofen and demonstrated a decrease in patients' use of narcotics. Other authors have also demonstrated that IV acetaminophen reduced opioid requirements [10,13,23]. 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.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies within the total joint arthroplasty patient population have demonstrated that IV acetaminophen has helped reduce patient LOS and opioid-related adverse events [9], decreases patients' reported pain scores [10,11] and overall opioid requirements [10], and decreases the need for rescue opioids [12]. However, 2 recent meta-analyses have demonstrated mixed results [13,14].…”

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confidence: 99%

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

Eftekhary

Wiznia

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Eftekhary

Wiznia

et al. 2020

The Journal of Arthroplasty

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundThe efficacy of intravenous acetaminophen in multimodal pain management in patients undergoing total knee arthroplasty (TKA) is controversial. The purpose of this meta-analysis was to compare the efficacy of intravenous acetaminophen versus placebo in TKA.MethodsRandomized controlled trials (RCTs) or retrospective cohort studies (RCSs) concerning related topics were retrieved from PubMed (1996–June 2018), Embase (1980–June 2018), and the Cochrane Library (CENTRAL June 2018). Any studies comparing intravenous acetaminophen with a placebo were included in this meta-analysis. Meta-analysis results were collected and analyzed by Stata 12.0. Subgroup analysis was performed according to the general characteristics of the patients.ResultsIn total, the patients from six studies met the inclusion criteria. Our meta-analysis results indicated that compared with a control group, intravenous acetaminophen was associated with reductions in total morphine consumption and visual analogue scale (VAS) score at postoperative day (POD) 3. However, there was no significant difference in morphine consumption at POD 1 or in VAS at POD 1 or POD 2. Moreover, there was no significant difference in the length of hospital stay.ConclusionsBased on our results, intravenous acetaminophen in multimodal management has shown better efficacy in pain relief at POD 3 and has morphine-sparing effects. High-quality studies with more patients are needed in the future.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0950-7) contains supplementary material, which is available to authorized users.

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Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

Turan

Essber

Saasouh

et al. 2020

JAMA

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for the FACTOR Study Group IMPORTANCE Opioid-induced ventilatory depression and hypoxemia is common, severe, and often unrecognized in postoperative patients. To the extent that nonopioid analgesics reduce opioid consumption, they may decrease postoperative hypoxemia.OBJECTIVE To test the hypothesis that duration of hypoxemia is less in patients given intravenous acetaminophen than those given placebo. DESIGN, SETTING, AND PARTICIPANTS Randomized, placebo-controlled, double-blind trial conducted at 2 US academic hospitals among 570 patients who were undergoing abdominal surgery, enrolled from February 2015 through October 2018 and followed up until February 2019.INTERVENTIONS Participants were randomized to receive either intravenous acetaminophen, 1 g (n = 289), or normal saline placebo (n = 291) starting at the beginning of surgery and repeated every 6 hours until 48 postoperative hours or hospital discharge, whichever occurred first. MAIN OUTCOMES AND MEASURESThe primary outcome was the total duration of hypoxemia (hemoglobin oxygen saturation [SpO 2 ] <90%) per hour, with oxygen saturation measured continuously for 48 postoperative hours. Secondary outcomes were postoperative opioid consumption, pain (0-10-point scale; 0: no pain; 10: the most pain imaginable), nausea and vomiting, sedation, minimal alveolar concentration of volatile anesthetic, fatigue, active time, and respiratory function.RESULTS Among 580 patients randomized (mean age, 49 years; 48% women), 570 (98%) completed the trial. The primary outcome, median duration with SpO 2 of less than 90%, was 0.7 (interquartile range [IQR], 0.1-5.1) minutes per hour among patients in the acetaminophen group and 1.1 (IQR, 0.1-6.6) minutes per hour among patients in the placebo group (P = .29), with an estimated median difference of −0.04 (95% CI,−0.18 to 0.11) minutes per hour. None of the 8 secondary end points differed significantly between the acetaminophen and placebo groups. Mean pain scores within initial 48 postoperative hours were 4.2 (SD, 1.8) in the acetaminophen group and 4.4 (SD, 1.8) in the placebo group (difference, −0.28; 95% CI, -0.71 to 0.15); median opioid use in morphine equivalents was 50 mg (IQR, 18-122 mg) and 58 mg (IQR, 24-151 mg) , respectively, with a ratio of geometric means of 0.86 (95% CI, 0.61-1.21).CONCLUSIONS AND RELEVANCE Among patients who underwent abdominal surgery, use of postoperative intravenous acetaminophen, compared with placebo, did not significantly reduce the duration of postoperative hypoxemia over 48 hours. The study findings do not support the use of intravenous acetaminophen for this purpose.

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Efficacy of Intravenous Acetaminophen for Postoperative Analgesia in Primary Total Knee Arthroplasty

Cited by 21 publications

References 18 publications

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

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

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

Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

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