Oral versus intravenous acetaminophen for perioperative pain management in adult patients undergoing non-cardiac surgery: A quantile segmented regression analysis
Authors' conclusion
In adult patients undergoing non-cardiac surgery of <6 h duration, preferential use of enteral rather than parenteral acetaminophen is associated with non-inferior outcomes in narcotic requirements, pain scores, time to PACU discharge, and probability of PONV when compared with routine parenteral administration.
Study context
- Population
- Adults, ASA 1–5, non-pregnant, undergoing non-cardiac surgery <6 hours, admitted to post anesthesia care unit (PACU)included in analysis
- Participants
- 24,701 adults
- Exposure
- Preferential enteral vs parenteral acetaminophen
- Pre-initiativen = 12,379reference
- Post-initiativen = 12,322
- Outcome
- Narcotic consumption in the PACU
Methodological detailsquantile segmented regression analysis, pre/post initiative, single tertiary academic medical center
- Quantile segmented regression analysis
- Pre/post initiative
- Single tertiary academic medical center
Main finding
As reported in the abstract
- No significant difference in level change of intraoperative or PACU narcotic administration
- Adjusted for period, day, age, gender, inpatient status, ASA class
Observational data: associations, not effects.
Secondary outcomes
Acetaminophen administration route
- Enteral acetaminophen administration increased preoperatively
- 13.49% to 26.84%
- Enteral acetaminophen administration increased postoperatively
- 43.16% to 51.45%
- Intraoperative parenteral APAP use dropped
- 43.23% to 6.81%
Adjusted median perioperative acetaminophen dose
- Decrease in adjusted median perioperative acetaminophen dose (mg), P < 0.001
- −175
- Adjusted for period, day, age, gender, inpatient status, and ASA class
Intraoperative narcotic administration
- No significant difference in level change
Time to meet criteria for PACU discharge
- Significant change in the slope, p = 0.007
- −0.36
- No significant difference in median time
Pain score (0-10 NRS) at PACU admission
- Median pain scores did not change
Pain score (0-10 NRS) at PACU discharge
- Median pain scores decreased slightly, p < 0.001
- −0.24
PONV
- No change in the probability of PONV
Safety
Probability of PONV
- No change
Original publication
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