Increased Postoperative Opioid Consumption in the Presence of Coadministration of 5-Hydroxytryptamine Type 3 Antagonists with Acetaminophen: A Hospital Registry Study

Ratajczak, N; Munoz-Acuna, R; Redaelli, S; Suleiman, A; Seibold, EL; von Wedel, D; Shay, D; Ashrafian, S; Chen, G; Sundar, E; Ahrens, E; Wachtendorf, LJ; Schaefer, MS

doi:10.1097/aln.0000000000005033

Pain medicine

Increased Postoperative Opioid Consumption in the Presence of Coadministration of 5-Hydroxytryptamine Type 3 Antagonists with Acetaminophen: A Hospital Registry Study

AnesthesiologyPublished 3 May 2024Retrospective cohort study

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Authors' conclusion

A dose-dependent association of pre- or intraoperative acetaminophen with decreased postoperative opioid consumption was not observed when 5-HT3 antagonists were coadministered

Study context

Population: Adults undergoing GA for ambulatory procedures at a tertiary centre in Massachusetts, 2015 to 2022
Participants: 55,016 adults

Exposure: Acetaminophen vs no acetaminophen, with vs without intraoperative 5-HT3 antagonists
Acetaminophen onlyn = 3,166
5-HT3 antagonists onlyn = 15,438
Both drugsn = 31,850
Neither drugn = 4,562reference
Outcome: Postoperative opioid consumption (PACU opioid dose, mg oral morphine equivalents)

Methodological detailshospital registry, single-centre, multivariable zero-inflated negative binomial regression

Hospital registry
Single-centre
Multivariable zero-inflated negative binomial regression

Main finding

As reported in the abstract

PACU opioid consumption, effect of acetaminophen by 5-HT3 antagonist use

Adjusted absolute difference, mg OME (95% CI)P value

Acetaminophen only vs Neither drugrelative reduction −5.5% (95% CI, −9.6 to −1.4%; P = 0.009)

−0.19(−0.33 to −0.05)

P = 0.009

Both drugs vs 5-HT3 antagonists only

0.00(−0.06 to 0.05)

P = 0.93

Observational data: associations, not effects.

Further findings

PACU opioid dose, all patients

Patients receiving opioids: 16,640 of 55,016 (30.2%)
Median dose among those receiving opioids (IQR 7.5 to 14.3 mg oral morphine equivalents (OME)): 7.5 mg OME
Mean dose across all patients: 3.2 mg OME
Maximum cumulative dose: 20.4 mg OME

Original publication

Increased Postoperative Opioid Consumption in the Presence of Coadministration of 5-Hydroxytryptamine Type 3 Antagonists with Acetaminophen: A Hospital Registry Study. Anesthesiology. Published 3 May 2024. doi:10.1097/aln.0000000000005033

Read the original article ↗

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