Perioperative IV acetaminophen may not impact opioid use after minimally invasive spine surgeries

Perioperative IV acetaminophen did not affect intraoperative or postoperative opioid use and pain score after minimally invasive spine surgeries, according to results presented at the Regional Anesthesiology and Acute Pain Medicine Meeting.

Perspective from Kern Singh, MD

“While IV acetaminophen may benefit a carefully selected subset of patients undergoing surgery, more work needs to be done to determine which patients will have the greatest benefit,” researchers wrote in the abstract. “Due to the cost and difficulty obtaining IV acetaminophen in some institutions, our findings suggest that IV acetaminophen may not be necessary in the average patient undergoing minimally invasive spine surgery.”

Researchers performed a retrospective chart review of 187 patients who underwent minimally invasive discectomy decompression or laminectomy between 2014 and 2018 at either the Keck Medical Center or the Verdugo Hills Hospital. They divided medical charts into two groups which included patients who received IV acetaminophen and patients who did not. The two groups were compared with regard to the total dose of opioids administered during and after surgery. The initial, maximum and mean VAS pain scores were compared between the two groups. Patients who received IV acetaminophen in the first hour after surgical incision were compared with patients who received IV acetaminophen after the first hour of surgery.

Results showed patients who received IV acetaminophen compared with patients who did not were not significantly different with regard to the total intraoperative morphine-milligram equivalents. Investigators noted the total morphine-milligram equivalents at postoperative day 0 and postoperative day 1 were also not significantly different between patients who received IV acetaminophen and those who did not.

Groups were not different with regard to the initial, maximum or mean postoperative VAS pain scores. Outcome measures were not different within the group of patients who received IV acetaminophen in the first hour of surgery or after the first hour of surgery. – by Monica Jaramillo

References:

Le Clair M, et al. Abstract 6751. Presented at: Regional Anesthesiology and Acute Pain Medicine Meeting; April 11-13, 2019; Las Vegas.

www.newswise.com/articles/view/710510/?sc=dwhr&xy=10007438

Disclosure: Le Clair reports no relevant financial disclosures.

Perspective

Kern Singh, MD

A recent study by LeClair and colleagues presented at the 2019 Regional Anesthesiology and Acute Pain Medicine Meeting examined the influence of perioperative IV administration of the non-opioid analgesic acetaminophen on postoperative pain and narcotics consumption. One hundred and eighty-seven patients who underwent minimally invasive (MIS) discectomy, decompression or laminectomy were retrospectively reviewed. Regardless of whether patients received IV acetaminophen intraoperatively, there were no differences in the total amount of narcotics consumed or the pain scores reported in the inpatient setting following surgery. Additionally, the timing of acetaminophen administration (before or after the first hour of surgery) did not affect outcomes.

Previous studies have suggested that postoperative pain may involve several pathways including inflammatory, neuropathic and nociceptive pain responses. Pain management protocols that simultaneously act upon multiple pathways can provide a synergistic effect. LeClair and colleagues contribute to the current body of knowledge by demonstrating that acetaminophen alone may not have a significant effect on postoperative pain or narcotics usage. Therefore, a multimodal analgesia regimen that combines the perioperative administration of anesthetics and non-opioid medications could be more effective than utilizing a single therapeutic measure.

LeClair’s investigation could be strengthened by assessing pain scores and narcotics use during the long-term convalescent period after hospital discharge. It may also benefit from taking into account any consumption of narcotics preoperatively and its potential effects on postoperative pain and opioid use. Given the increasing efforts to mitigate the widespread use of opioids and their associated adverse events, LeClair’s study provides valuable insight into this important topic by illustrating that IV acetaminophen administration alone may not be the optimal solution in reducing pain and narcotics use following MIS spine surgery.

References:

Jirarattanaphochai K, et al. J Neurosurg Spine. 2008;doi:10.3171/SPI/2008/9/7/022.

Mathiesen O, et al. Eur Spine J. 2013; doi:10.1007/s00586-013-2826-1.

Rivkin A, et al. Am J Health Syst Pharm. 2014;doi:10.2146/ajhp130688.

Kern Singh, MD

Joon S. Yoo, BA

Department of orthopedic surgery

Rush University Medical Center

Chicago

Disclosures: Yoo and Singh report no relevant financial disclosures.