The role of intravenous acetaminophen in post‐operative pain control in head and neck cancer patients

Smith, Elizabeth; Lange, Jessica L; Moore, C. Ulysses; Eid, Isaam; Jackson, Lana; Monico, Jesus

doi:10.1002/lio2.254

Cited by 15 publications

(25 citation statements)

References 12 publications

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“…The average score was 15.1 ± 1.6, with all studies reporting a clearly stated aim, end points appropriate to study aim, follow-up period appropriate to study aim, and an adequate control group. Five studies 15-18,20 included consecutive patients while 1 study 21 included prospective data collection with the other studies comparing against historical data. Only 1 study performed a prospective calculation of study size.…”

Section: Resultsmentioning

confidence: 99%

Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Chorath

et al. 2021

Otolaryngol.--head neck surg.

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Objective Postoperative pain after head and neck cancer surgery is commonly treated with opioids, which are associated with considerable side effects. The objective of this study is to analyze the safety and efficacy of using multimodal analgesia (MMA) for patients undergoing head and neck cancer surgery with free flap reconstruction. Data Sources A systematic search was conducted in PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov. Review Methods All studies comparing patients receiving MMA (gabapentin, corticosteroids, local anesthetic, acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]) vs patients receiving opioids for head and neck cancer surgery with free flap reconstruction were screened. The primary outcome was postoperative opioid usage. Secondary outcomes included length of stay, subjective pain scores, surgical/medical complications, adverse effects, and 30-day outcomes. Results A total of 10 studies representing 1253 patients (MMA, n = 594; non-MMA, n = 659) met inclusion criteria. Gabapentinoids were the most commonly used intervention (72.9%) followed by NSAIDs (44.6%), acetaminophen (44.3%), corticosteroids (25.1%), ketamine (7.2%), and nerve block (3.4%). Eight studies reported a significant decrease in postoperative opioid usage in the MMA groups. Subjective pain had wider variation, with most studies citing significant pain improvement. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates. Conclusion With the rise of the opioid epidemic, MMA may play an important role in the treatment of postoperative pain after head and neck cancer surgery. A growing body of literature demonstrates a variety of effective perioperative regimens.

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Section: Resultsmentioning

confidence: 99%

Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Chorath

et al. 2021

Otolaryngol.--head neck surg.

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“…25 Alternative pain regimens show promise (eg, acetaminophen, gabapentin, celecoxib, lidocaine), but more studies are needed in patients with head and neck cancer. [26][27][28][29][30][31] During this study period, there was not a specific institutional protocol for pain management during or after treatment. However, following the results of this study, we have implemented the prophylactic use of gabapentin during RT as well as increased utilization of alternative pain regimens perioperatively.…”

Section: Discussionmentioning

confidence: 99%

Implications of Treatment Modality on Chronic Opioid Use Following Treatment for Head and Neck Cancer

Bollig

Kinealy

Gilley

et al. 2020

Otolaryngol.--head neck surg.

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Objective To investigate the relationship between treatment modality and chronic opioid use in a large cohort of patients with head and neck cancer. Study Design Retrospective cohort study. Setting Single academic center. Methods There were 388 patients with head and neck cancer treated between January 2011 and December 2017 who met inclusion criteria. Clinical risk factors for opioid use at 3 and 6 months were determined with univariate and multivariate analyses. Results The prevalence of opioid use was 43.0% at 3 months and 33.2% at 6 months. On multivariate analysis, primary chemoradiation (odds ratio [OR], 4.04; 95% CI, 1.91-8.55) and surgery with adjuvant chemoradiation (OR, 2.39; 95% CI, 1.09-5.26) were associated with opioid use at 3 months. Additional risk factors at that time point included pretreatment opioid use (OR, 7.63; 95% CI, 4.09-14.21) and decreasing age (OR, 1.03; 95% CI, 1.01-1.06). At 6 months, primary chemoradiation (OR, 2.40; 95% CI, 1.34-4.28), pretreatment opioid use (OR, 5.86; 95% CI, 3.30-10.38), current tobacco use (OR, 2.00; 95% CI, 1.18-3.40), and psychiatric disorder (OR, 1.79; 95% CI, 1.02-3.14) were associated with opioid use. Conclusion Of the patients who receive different treatment modalities, those receiving primary chemoradiation are independently at highest risk for chronic opioid use. Other risk factors include pretreatment opioid use, tobacco use, and a psychiatric disorder. In an effort to reduce their risk of chronic opioid use, preventative strategies should be especially directed to these patients.

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“…Some studies have reported that intravenous acetaminophen spares opioid use and reduces postoperative pain. 6,[18][19][20] A recent study in elderly patients recovering from cardiac surgery reported that intravenous acetaminophen decreased opioid consumption and reduced delirium. 21 .…”

Section: Discussionmentioning

confidence: 99%

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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The role of intravenous acetaminophen in post‐operative pain control in head and neck cancer patients

Cited by 15 publications

References 12 publications

Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Implications of Treatment Modality on Chronic Opioid Use Following Treatment for Head and Neck Cancer

Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

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