Article Text
PDF
Abstract
Introduction As ambulatory spine surgery increases, efficient recovery and discharge become essential. Multimodal analgesia is superior to opioids alone. Acetaminophen is a central component of multimodal protocols and both intravenous and oral forms are used. While some advantages for intravenous acetaminophen have been touted, prospective studies with patient-centered outcomes are lacking in ambulatory spine surgery. A substantial cost difference exists. We hypothesized that intravenous acetaminophen would be associated with fewer opioids and better recovery.
Methods Patients undergoing ambulatory spine surgery were randomized to preoperative oral placebo and intraoperative intravenous acetaminophen or preoperative oral acetaminophen. All patients received general anesthesia and multimodal analgesia. The primary outcome was 24-hour opioid use in intravenous morphine milligram equivalents (MMEs), beginning with arrival to the postanesthesia care unit (PACU). Secondary outcomes included pain, Quality of Recovery (QoR)-15 scores, postoperative nausea and vomiting, recovery time, and correlations between pain catastrophizing, QoR-15, and pain.
Results A total of 82 patients were included in final analyses. Demographics were similar between groups. For the primary outcome, the median 24-hour MMEs did not differ between groups (12.6 (4.0, 27.1) vs 12.0 (4.0, 29.5) mg, p=0.893). Postoperative pain ratings, PACU MMEs, QoR-15 scores, and recovery time showed no differences. Spearman’s correlation showed a moderate negative correlation between postoperative opioid use and QoR-15.
Conclusion Intravenous acetaminophen was not superior to the oral form in ambulatory spine surgery patients. This does not support routine use of the more expensive intravenous form to improve recovery and accelerate discharge.
Trial registration number NCT04574778.
- analgesics, opioid
- ambulatory care
- analgesia
- pain, postoperative
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @ESchwenkMD
Contributors ESS helped design study, analyze data, and prepare manuscript and is the guarantor for the content of the manuscript. PF helped analyze data and prepare manuscript. MCT helped design study, analyze data, and prepare manuscript. CJL helped collect data and prepare manuscript. ARC helped collect data and prepare manuscript. VZY helped analyze data and prepare manuscript. MAM helped collect data and prepare manuscript. ANF helped design the study and prepare the manuscript. TI helped collect data and prepare the manuscript. CKK helped prepare manuscript. GDS helped prepare manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CKK has received royalties from Curetiva and Inion, research support from the National Institute of Health and the CSRS, and is on the editorial board of Clinical Spine Surgery. GDS has received royalties and consultation fees from Camber, research support from Medtronic and AOSpine, and is the editor-in-chief for Clinical Spine Surgery.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.