Intravenous Versus Oral Acetaminophen in Outpatient Cystoscopy Procedures: Retrospective Comparison of Postoperative Opioid Requirements and Analgesia Scores

Abstract

Purpose To assess if the choice of acetaminophen formulation (intravenous vs oral) when administered preoperatively for ambulatory cystoscopy procedures is associated with differences in anesthetic outcomes. Methods Medical records of adult patients undergoing ambulatory cystoscopy procedures at an outpatient procedural center from July 1, 2014, through November 30, 2017, were abstracted. The association between anesthetic outcomes (severe pain, rescue opioids, postoperative nausea, and vomiting) and acetaminophen formulation was assessed. Propensity-adjusted analyses were performed using inverse probability of treatment weighting to account for potential confounders. Results During the study time frame, there were 611 intravenous and 2955 oral acetaminophen administrations for cystoscopy procedures. Postoperative bladder spasms were a major contributor to severe pain and complicated 1036 cases, with similar rates between intravenous (N = 183, 29.9%) and oral (N = 853, 28.9%) formulations, P = .625. After adjusting for bladder spasms, intravenous acetaminophen was associated with longer anesthesia recovery (estimate 5.2 [95% CI 0.5-9.9] minutes, P = .030), use of rescue opioids (odds ratio 1.33 [1.07-1.66], P = .012), and postoperative nausea and vomiting (1.40 [1.02-1.93], P = .037), but not severe pain (1.07 [0.81-1.40], P = .640). Conclusion Preoperative intravenous acetaminophen compared to oral acetaminophen for ambulatory cystoscopy procedures was not associated with better anesthetic outcomes. Bladder spasms were a major contributor to postoperative pain.

Pain reduction methods during transurethral cystoscopy

“…Moreover, other drugs can also be used successfully, such as pipemidic acid, phenazopyridine and paracetamol [ 61 , 68 ]. A comparison between the oral administration of pipemidic acid, phenazopyridine and diclofenac indicated that pipemidic acid was superior to the other two drugs (based on the VAS score) [ 61 ].…”

“…Finally, a study comparing oral and intravenous paracetamol use in ambulatory CS showed no difference in pain levels, with more complications after intravenous administration of acetaminophen [ 68 ]. This leads to the conclusion that parenteral administration of analgesics should be avoided unless necessary.…”

Actualización en alternativas para control del dolor posoperatorio en cirugía plástica

“…Las técnicas analgésicas se han modificado para llevar este manejo al ámbito domiciliario del paciente y, en este grupo seleccionado de pacientes, la posibilidad de realizar analgesia invasiva domiciliaria como gran avance en el control del dolor es contundente. El uso de técnicas regionales continuas podría simplificar el tratamiento y ahorrar costos de enfermería [5], [6], [7].…”

Response from Authors to Letter to the Editor “Comparison of Preoperative Intravenous and Oral Acetaminophen: Methodological Issues”

“…We recognize that since our initial inquiry and literature search in early 2017, there are multiple published studies at the time of publication of our study (2020). [5][6][7][8][9][10][11][12][13][14][15] Because at the time of protocol development there was no published effect size of the primary outcome variable, the authors calculated a sample size required to detect a clinically significant difference in pain scores. The consensus of the study team was that a 2point difference on a 0 to 10 pain rating scale would be clinically significant.…”