Background
Cesarean delivery is a common surgery in the United States, with 1.3 million performed
during 2009.
1
Obstetricians must balance the growing concern with opioid abuse, dependence, and
side effects with optimal postoperative pain control. Intravenous acetaminophen may
represent an additional method to decrease the reliance on opioid medications and
improve postoperative pain following cesarean delivery.Objective
The objective of the study was to determine whether the administration of intravenous
acetaminophen following routine scheduled cesarean delivery would decrease the need
for narcotic medications to control postoperative pain.
Study Design
This was an institutional review board–approved, double-blind, placebo-controlled,
randomized trial, registered on clinicaltrials.gov (number 02046382). Women scheduled to undergo cesarean delivery with regional anesthesia
at term were recruited. All perioperative and postpartum care was standardized via
study order sets. Study patients were given all medications in a standardized manner
receiving either acetaminophen 1000 mg intravenously or 100 mL saline (placebo) every
8 hours for 48 hours for a total of 6 doses. The pharmacy prepared intravenous acetaminophen
and saline in identical administration bags labeled study drug to ensure blinding.
The initial dose of study drug was given within 60 minutes of skin incision. Quantity
of breakthrough and scheduled analgesic medications and self-reported pain levels
on the Faces Pain Scale (0–10) before and after study drug administration were collected.
Patient demographics were extracted from the chart. Power calculation determined that
45 patients per arm were required to detect a 30% reduction in postcesarean narcotic
requirement with 80% power and a significance level of P = .05.
Results
A total of 133 patients were consented for the study. Twenty-nine were excluded and
104 patients completed the study: 57 received intravenous acetaminophen and 47 received
placebo. There were no differences in baseline demographic characteristics including
patient age, body mass index, gravidity, parity, race, comorbidities, or number of
prior cesarean deliveries. There were no differences between groups in estimated blood
loss or length of stay. The total amount of oral narcotic medications consumed by
patients receiving intravenous acetaminophen was significantly reduced when compared
with the placebo group (47 mg vs 65 mg of oxycodone; P = .034). The total amount of ibuprofen used between groups was not different. There
was no difference in pain scores between groups before and after study dose administration.
There was no significant difference in narcotic side effects (nausea/emesis, respiratory
depression, constipation) in either study arm.
Conclusion
Intravenous acetaminophen in the postoperative period following cesarean delivery
resulted in a significant decrease in oral narcotic consumption for pain control.
Key words
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Article info
Publication history
Published online: April 25, 2017
Accepted:
April 17,
2017
Received:
March 3,
2017
Footnotes
This study was supported by Graduate Medical Education Quality Improvement Funds, TriHealth Hospitals, Cincinnati, OH.
The authors report no conflict of interest.
Cite this article as: Altenau B, Crisp CC, Devaiah CG, et al. Randomized controlled trial of intravenous acetaminophen for postcesarean delivery pain control. Am J Obstet Gynecol 2017;217:362.e1-6.
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© 2017 Elsevier Inc. All rights reserved.
