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IV acetaminophen shows limited benefits after colorectal surgery
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Intravenous acetaminophen was no more effective than oral delivery for patients who underwent colectomy, being associated with only marginal reductions in opioid use after surgery, according to research published in Anesthesiology.
Although IV acetaminophen was used in only a minority of patients, these findings suggest its use should be eliminated, as it is much more expensive than its orally delivered counterpart, according to Jashvant Poeran, MD, PhD, assistant professor of population health and health science policy at the Icahn School of Medicine at Mount Sinai, and colleagues. This could lead to significant cost-savings for hospitals without impacting patient outcomes, they added.
Poeran and colleagues noted that IV acetaminophen was approved in the United States in 2010 and has since become quite common in clinical practice. However, little research has been conducted regarding its value for patients despite widespread use.
“With any new drug that is introduced to the U.S. market, it is very important to monitor how it is used and if this results in the desired outcomes,” Poeran said in a press release. “Our study results do not support routine use of IV acetaminophen.”
Poeran and colleagues analyzed data from a national database on patients who underwent colectomy between 2011 and 2016 (n = 181,640). They separated patients based on treatment with either oral or IV acetaminophen then further categorized patients into groups that received one dose or more than one dose on the day of surgery, postoperative day one, or later. Researchers measured associations between acetaminophen use and opioid use, as well as opioid-related adverse events.
Overall, 25.1% of the study group received IV acetaminophen, and 48% of those patients received one dose on the day of surgery (n = 21,878).
For patients treated with IV, Poeran and colleagues found the biggest reduction in opioid use in the groups that received more than one dose on the day of surgery (–8%; 99.5% CI, –11 to – 4.49) and those who received more than one dose on the day after surgery (–12.4%; 99.5% CI, –15.2 to –9.4).
However, patients who received more than one dose oral acetaminophen on postoperative day one experienced an even greater reduction in opioid use (–22.6%; 99.5% CI, –26.2 to –18.9).
Poeran and colleagues believe their findings showed that IV acetaminophen is not always used in the right way, because one dose on the day of surgery is not enough to affect opioid use for patients who undergo colectomy.
“It is important that we identify optimal dosing strategies and patients that are most likely to benefit from this relatively new drug. Especially among patients undergoing colorectal surgery, there may be a group of patients that do not tolerate oral medications,” Poeran said. “This may be less of an issue among patients undergoing other types of surgery, such as hip and knee replacement surgery, and these results further emphasize a more targeted approach in determining who benefits most.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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