Perioperative acetaminophen may decrease opioid consumption after rotator cuff repair

SAN DIEGO — Patients who received perioperative acetaminophen had significantly decreased opioid consumption following rotator cuff repair, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

Joseph A. Abboud, MD, and colleagues randomly assigned 57 patients undergoing primary arthroscopic rotator cuff repair to one of three groups. Group 1 received 5 mg of oxycodone every 6 hours as needed and 1,000 mg of acetaminophen every 6 hours as needed following surgery; group 2 received 5 mg of oxycodone every 6 hours as needed without any additional acetaminophen following surgery; and group 3 received 1,000 mg of acetaminophen every 6 hours 1 day prior to and following surgery, 1,000 mg of acetaminophen every 8 hours during postoperative days 2 through 5 and 5 mg of oxycodone every 6 hours as needed following surgery (group 3). Researchers recorded patient opioid use, pain scores, potential adverse events and overall satisfaction with the pain management regimen daily for the first week following surgery.

“With all the valid concerns about opioid use, we wanted to see if the incorporation of acetaminophen at a therapeutic level perioperatively would be effective,” Abboud, professor of orthopedic surgery at the Sydney Kimmel Medical College and Chief Medical Officer at Rothman Orthopaedic Institute, told Healio Orthopedics.

Results showed patients who received acetaminophen (groups 1 and 3) consumed significantly fewer narcotic pills each day on average, compared with patients in the oxycodone as needed group (group 2). Compared with groups 1 and 2, researchers noted patients in group 3 taking preoperative and postoperative acetaminophen reported significantly better overall pain control. Researchers found no significant difference in overall satisfaction between the groups, as well as no significant difference regarding postoperative medication-associated adverse events.

“So, the best cohort was the cohort that was pre-medicated with Tylenol and took Tylenol regularly after surgery,” Abboud said.

Abboud noted he found the significant difference in opioid use between the groups to be surprising, with patients who received acetaminophen before and after surgery consuming 10 fewer opioid pills compared with patients who did not receive acetaminophen.

“If you think about it over a period of 5 days, 10 less pills is very significant and there were even a few patients in the acetaminophen group that did not take any postoperative opioid pain medications, which was surprising,” Abboud said.