The Effect of Perioperative Intravenous Acetaminophen on Intraoperative and Postoperative Opioid Use and Pain Scores in Minimally Invasive Spine Surgery
Marie Le Clair, MD, Sachin Jha, MD, Eugenia Ayrian, MD
Keck School of Medicine of University of Southern California, Department of Anesthesiology, Los Angeles, CA, USA
Recovery after spine surgery is often accompanied by severe pain
Opioid pain medications are the current mainstay of treatment and are associated with side effects
Previous studies demonstrate a rationale for the use of IV acetaminophen in a multimodal analgesic regimen to reduce postoperative pain 1-5
It is our goal to explore the effect of acetaminophen on intraoperative and postoperative opioid use and postoperative pain scores, and to assess whether perioperative IV acetaminophen can reduce the amount of opioid required during and after spine surgery
Retrospective chart review of 187 patients undergoing minimally invasive discectomy, decompression, or laminectomy
Total dose of opioid administered during and after surgery was compared (24 hrs) in two groups: receiving versus not receiving intravenous acetaminophen
Within the IV acetaminophen group patients that received IV acetaminophen in the first hour after surgical incision were compared to patients that had received IV acetaminophen more than one hour after surgical incision
Initial, maximum, and mean visual analogue scale pain scores (VAS) compared between groups
A Wilcoxon-Mann-Whitney test was performed to assess if continuous variables differed by group. A
chi-square test or Fisher’s Exact test was performed to assess if the categorical variables differed by group.
Significance tests were two-tailed, with α=0.05.
Total intraoperative morphine milligram equivalents (MME) - no significant difference between groups (p=0.75)
Total postoperative day 0 (POD 0) and postoperative day 1 (POD 1) MME - no significant difference between groups (p=0.17)
Initial, maximum, mean postoperative pain scores - no significant difference between groups (p=0.16, p=0.25, p=0.35 respectively)
Patients receiving IV acetaminophen in the first hour versus more than one hour after surgical incision - no significant difference between groups
Our results do not show an effect of perioperative IV acetaminophen on intraoperative or postoperative opioid use or pain scores in minimally invasive spine surgeries.
Although previous literature supports the benefit of including multimodal analgesia as part of an intraoperative pain management plan, our results failed to identify a measurable effect of perioperative acetaminophen alone on opioid requirements or pain scores.
While intravenous 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.