Background
Opioids are effective for the treatment of postoperative pain but can cause nausea
and are associated with dependency with long-term use. Nonopioid medications such
as acetaminophen offer the promise of decreasing these nondesirable effects while
still providing patient comfort.
Objective
The purpose of this study was to compare intravenous acetaminophen with placebo and
to evaluate postoperative pain control and opioid usage after laparoscopic hysterectomy.
Study Design
We conducted a prospective double-blind randomized study with 183 patients who were
assigned randomly (1:1) to receive acetaminophen or placebo (Canadian Task Force Design
Classification I). Patients received either 1000 mg of acetaminophen (n=91) or a placebo
of saline solution (n=92) at the time of induction of anesthesia and a repeat dose
6 hours later. Both groups self-reported pain and nausea levels preoperatively and
at 2, 4, 6, 12, and 24 hours after extubation with the use of a visual analog scale
with a score of 0 for no pain to 10 for highest level of pain. Patients self-reported
pain, nausea, and postoperative oral opiates that were taken after discharge. All
opiates were converted to milligram equivalents of oral morphine for standardization.
Results
There were no significant differences in generalized abdominal pain at any time point
postoperatively that included 2 hours (placebo 3.6±2.5 vs acetaminophen 4.4±2.5; P=.07) and up to 24 hours (placebo 3.3±2.4 vs acetaminophen 3.6±2.5; P=.28). Similar results were observed for nausea scores. There were no differences
in opioid consumption at any time point including intraoperatively (placebo 4.4±3.9
vs acetaminophen 3.3±4.0; P=.06), post anesthesia care unit (placebo 10.5±10.3 vs acetaminophen 9.7±10.3; P=.59), and up to 24 hours after surgery (placebo 1.4±2.0 vs acetaminophen 1.6±2.1;
P=.61). There were no differences in demographics or surgical data between groups.
Conclusion
There was no difference between acetaminophen and placebo groups in postoperative
pain, satisfaction scores, or opioid requirements. Given the relatively high cost
($23.20 per dose in our study), lack of benefit, and available oral alternatives,
our results do not support routine use during hysterectomy.
Key words
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Article info
Publication history
Published online: January 22, 2019
Accepted:
January 14,
2019
Received in revised form:
January 8,
2019
Received:
October 11,
2018
Footnotes
Supported by Magee-Womens Hospital Medical Staff Grant.
The funders had no role in the study design, collection, analysis or interpretation of data nor in the writing of the report or decision to submit the article for publication.
The authors report no conflict of interest.
Cite this article as: Rindos NB, Mansuria SM, Ecker AM, et al. Intravenous acetaminophen vs saline in perioperative analgesia with laparoscopic hysterectomy. Am J Obstet Gynecol 2019;220:373.e1-8.
Identification
Copyright
© 2019 Published by Elsevier Inc.
