Intravenous Versus Oral Acetaminophen in Ambulatory Surgical Center Laparoscopic Cholecystectomies: A Retrospective Analysis

The primary aim was to compare postoperative pain scores in patients undergoing laparoscopic cholecystectomy and receiving intravenous (IV) or oral (PO) acetaminophen (APAP) as part of a multimodal analgesic regimen to examine whether PO APAP is non-inferior to IV APAP. Retrospective analysis. Ambul...

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Bibliographic Details
Published in:	P&T (Lawrenceville, N.J.) Vol. 44; no. 6; pp. 359 - 363
Main Authors:	Johnson, Ryan J, Nguyen, Danny K, Acosta, Jose M, O'Brien, Alice L, Doyle, Peter D, Medina-Rivera, Glorimar
Format:	Journal Article
Language:	English
Published:	United States MediMedia USA, Inc 01-06-2019
Subjects:	single-dose acetaminophen acetaminophen ambulatory surgical center Multimodal analgesia postoperative pain laparoscopic cholecystectomy
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Summary:	The primary aim was to compare postoperative pain scores in patients undergoing laparoscopic cholecystectomy and receiving intravenous (IV) or oral (PO) acetaminophen (APAP) as part of a multimodal analgesic regimen to examine whether PO APAP is non-inferior to IV APAP. Retrospective analysis. Ambulatory surgical center (ASC) in an academic setting. 579 patients (18-70 years old), American Society of Anesthesiologists physical status I-III, undergoing laparoscopic cholecystectomy. Patients received 1,000 mg IV APAP intraoperatively (n = 319) or 1,000 mg PO APAP preoperatively (n = 260). The primary outcome was the median difference in post-anesthesia care unit (PACU) end-pain scores between the groups. Median pain scores were also compared on PACU admission, and at 15, 30, 45, and 60 minutes. Additional measures include PACU rescue-analgesia consumption, time to first PACU rescue analgesia, intraoperative use of opioid and nonopioid analgesics, PACU length of stay, and PACU rescue nausea and vomiting therapy. In both groups, the PACU median end-pain score was 2. The 90% confidence interval (CI) for difference in median pain scores between groups was [0, 0]; the CI upper limit was below the non-inferior margin of 1 pain-score point, indicating PO APAP's non-inferiority to IV APAP. There were no statistically significant differences in the percentages of patients receiving PACU hydromorphone equivalents between the IV and PO groups (75% vs. 77%, = 0.72) or in the mean dose received (0.5 mg vs. 0.5 mg, = 0.66). Single-dose PO APAP is non-inferior to IV APAP for postoperative analgesia in ASC laparoscopic cholecystectomy patients. The value of single-dose IV APAP in this population should be further explored.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Mr. Johnson is a nurse anesthetist in the Department of Anesthesiology at the University of Texas McGovern Medical School in Houston, Texas; Dr. Nguyen is a pharmacist at the University of Washington in Seattle, Washington; Dr. Acosta is a nurse anesthetist in the Department of Anesthesiology at the University of Texas McGovern Medical School; Dr. O’Brien is an associate professor at the Baylor College of Medicine Department of Anesthesiology in Houston; Dr. Doyle is an associate professor in the Department of Anesthesiology at the University of Texas McGovern Medical School; and Dr. Medina-Rivera is an assistant professor in the Department of Anesthesiology at the University of Texas McGovern Medical School.
ISSN:	1052-1372