The impact of intravenous acetaminophen on pain after abdominal surgery: a meta-analysis

Blank, Jacqueline J.; Berger, Nicholas G.; Dux, Justin; Ali, Fadwa; Ludwig, Kirk; Peterson, Carrie Y.

doi:10.1016/j.jss.2018.02.032

Cited by 15 publications

(12 citation statements)

References 27 publications

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“…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.…”

Section: Introductionsupporting

confidence: 66%

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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Section: Introductionsupporting

confidence: 66%

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

et al. 2018

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“…Similarly a review of abdominal surgery did not find 12-hour pain scores and 24-hour opioid consumption to differ between patients who received IV acetaminophen or placebo. 18 As approximately 85% of patients in the current study presented with abdominal pain, it is possible that IV acetaminophen is less effective for abdominal pain than for other specific types of pain.…”

Section: Discussionmentioning

confidence: 87%

Randomized Clinical Trial of Intravenous (IV) Acetaminophen as an Adjunct to IV Hydromorphone for Acute Severe Pain in Emergency Department Patients

Bijur

Friedman

White

et al. 2020

Academic Emergency Medicine

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Background A fundamental challenge for emergency department (ED) clinicians is to relieve severe, acute pain while simultaneously avoiding adverse events associated with opioid analgesics. Because there is evidence that intravenous (IV) acetaminophen is an effective adjuvant analgesic in postoperative settings, we examined whether it also has a role in the ED. Methods This was a two‐arm, double‐blind randomized clinical trial. All patients received 1 mg of IV hydromorphone. Patients were then randomized to receive 1 g of IV acetaminophen or placebo. The primary outcome was the between‐group difference in change in pain from baseline (before treatment) to 60 minutes after administration of study drugs, measured on an 11‐point numeric rating scale (NRS). Results Of 828 patients screened, 162 were enrolled and 159 had the primary outcome. Patients allocated to acetaminophen + hydromorphone had a mean decline in pain from baseline to 60 minutes of 6.2 NRS units; those receiving placebo + hydromorphone had a mean decline of 5.4, a difference of 0.8 NRS units (95% confidence interval [CI] = −0.01 to 1.8). Two patients in each group received additional analgesics in the first 60 minutes of the study. At 120 minutes the NRS pain difference was 0.6 (95% CI = –0.4 to 1.6). A total of 26.9% of patients who received acetaminophen wanted more analgesia versus 37.7% of those given placebo (difference = –10.8%, 95% CI = −24.3% to 4.4%). The incidence of adverse effects was similar in both groups. Conclusions The addition of 1 g of IV acetaminophen to 1 mg of IV hydromorphone provided neither clinically meaningful nor statistically superior analgesia than hydromorphone alone.

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“…Meta-analyses and larger population-based studies yield similarly equivocal results. Blank et al 34 summarized 17 prospective studies where intravenous APAP’s ability to reduce opioid consumption over 24 hours after abdominal surgery was analyzed. While no significant impact of intravenous APAP on 12-hour or 24-hour narcotic requirements could be detected overall, subgroup analysis suggested that patients undergoing open laparotomy would benefit most from intravenous APAP, and that other analgesic agents showed a more pronounced effect with regard to the main outcome.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study

Stundner

Poeran

Ladenhauf

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesThe significance of intravenous over oral acetaminophen (APAP) as part of multimodal analgesic protocols is contested, particularly when considering its relatively high price and use in a surgical cohort such as total hip or knee arthroplasty (THA/TKA), which generally tolerates oral medications. This study aims to elucidate APAP’s effectiveness in a large, population-based patient sample.Methods1 039 647 THA/TKA procedures were sampled from the Premier Healthcare claims database 2011–2016. APAP use was categorized by intravenous/oral and use on the day of surgery, postoperative day 1 and thereafter. Outcomes were opioid utilization (in oral morphine equivalents), length and cost of hospitalization, and opioid-related adverse effects (respiratory, gastrointestinal, and naloxone use as a proxy). Mixed-effects models measured the associations between intravenous/oral APAP use and outcomes. Percent (%) change and 95% CIs are reported.ResultsOverall, 23.6% (n=245 454) of patients received intravenous APAP; of these, 56.3% (n=138 180) received just one dose on the day of surgery. After adjustment for relevant covariates, particularly use of >1 dose of intravenous APAP (compared with no use) on postoperative day 1 was associated with −6.0% (CI −7.2% to −4.7%) reduced opioid utilization; this was −10.7% (CI −11.4% to -9.9%) for use of > 1 dose oral APAP on postoperative day 1. Further comparisons regarding other outcomes also favored oral (over intravenous) APAP.ConclusionsThese results do not support the routine use of intravenous APAP in patients undergoing lower joint arthroplasty, especially since oral APAP shows more beneficial outcome patterns.

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The impact of intravenous acetaminophen on pain after abdominal surgery: a meta-analysis

Cited by 15 publications

References 27 publications

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

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

Randomized Clinical Trial of Intravenous (IV) Acetaminophen as an Adjunct to IV Hydromorphone for Acute Severe Pain in Emergency Department Patients

Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study

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