There was no significant difference in pain scores comparing IV acetaminophen to placebo in adult patients undergoing abdominal surgery. The remaining findings measuring difference in pain scores at various points in the post-operative period were inconsistent, therefore limiting the ability to draw firm conclusions. One SR found that IV acetaminophen was superior to placebo in the proportion of adult patients undergoing any surgical procedure achieving at least 50% pain relief four or six hours after administration of IV medication. This report was undertaken to examine the current evidence surrounding the clinical and cost-effectiveness of IV acetaminophen in order to inform decision-makers on whether there is value in wider adoption of this product for local use.Įvidence identified from seven systematic reviews was limited in methodological quality and was heterogeneous regarding patient populations, comparators, and time and duration of intravenous acetaminophen administration. Given its potential demand for use, particularly for immediate post-operative pain, there is a need to demonstrate whether the addition of IV acetaminophen to the multimodal pain pathway for adult patients requiring post-operative analgesia would be clinically as well as cost-effective. 8 Compared to rectal or oral administration, IV acetaminophen produces earlier and higher peak CSF concentration values with less variability. 15 IV acetaminophen can theoretically enhance bioavailability and provide an earlier onset of analgesic effect in the immediate post-operative period. After IV administration of acetaminophen, a rapid and high plasma concentration has been achieved within five minutes, and pain relief occurs within a few minutes. Recently, acetaminophen has been made available in intravenous (IV) form, which has provided an opportunity for it to be used in perioperative and early post-operative period. 10 Oral acetaminophen is commonly used as an analgesic several days after surgery since slowed gastric emptying and enteral absorption in the first 24 hours after surgery has limited its use in the early perioperative setting, even when administered rectally. Given its favourable safety profile, it has become a common household drug and has been available in oral form since 1950. 9 It is believed to provide analgesic effects by preventing prostaglandin production in the central nervous system and working peripherally to inhibit pain impulses. 8 The mechanism by which acetaminophen prevents and reduces pain is yet to be fully elucidated. It is able to easily pass through the blood-brain barrier, and is able to reach high concentration levels in the cerebrospinal fluid. 6, 7Īcetaminophen is a widely used analgesic that is a nonopioid option in multimodal analgesia. 3 Multimodal analgesia is able to improve recovery outcomes after surgery, ensuring rehabilitation while reducing overall costs. 3 This ultimately results in lower doses of respective agents required to lessen side effects while providing adequate analgesia. 3 Systemic analgesics, such as NSAIDs, acetaminophen, antidepressants, and alpha 2 receptor agonists, as well as local anesthetics, can reduce activation of pain receptors and the production or activity of pain-related neurotransmitters. 5 Multimodal analgesia is currently the preferred approach to treating post-operative pain, utilizing different classes of analgesics with different pathways and receptors. 1 One study estimated that there was a 3% incidence of prolonged opioid use following major elective surgery. 4 More severe adverse events include respiratory depression and sedation, which can increase risk of respiratory failure, aspiration, decreased mobility, and falls. Monotherapy with opioids has previously been the mainstay of treatment for post-operative pain, however these agents are associated with various adverse events, such as nausea, vomiting, and constipation, which can result in significant discomfort and possibly increase hospital stays. 2 There is also a risk of long-term complications from untreated post-operative pain, including worsening functional outcomes and chronic pain syndromes. 1 Furthermore, this pain is often associated with poor outcomes, including longer hospital stays, delayed mobilization, higher rates of medical complications, and decreased patient satisfaction. Acute pain in the post-operative setting is common and often sub-optimally managed.
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