TY - JOUR
T1 - Scheduled Intravenous Acetaminophen Improves Patient Satisfaction with Postcraniotomy Pain Management
T2 - A Prospective, Randomized, Placebo-controlled, Double-blind Study
AU - Artime, Carlos A.
AU - Aijazi, Hassan
AU - Zhang, Haijun
AU - Syed, Tariq
AU - Cai, Chunyan
AU - Gumbert, Sam D.
AU - Ferrario, Lara
AU - Normand, Katherine C.
AU - Williams, George W.
AU - Hagberg, Carin A.
N1 - Funding Information:
C.C. was supported by the National Institutes of Health’s Clinical and Translational Science Award Grant (UL1 TR000371), awarded to the University of Texas Health Science Center at Houston in 2012 by the National Center for Clinical and Translational Sciences. The re-maining authors have no conflicts of interest to disclose.
Funding Information:
This study was sponsored by Mallinckrodt Pharmaceuticals, St. Louis, MO.
Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Background: Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy. Materials and Methods: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery. Total 24-hour opioid consumption, pain scores, satisfaction with overall pain management, time to meet postanesthesia care unit discharge criteria, and incidence of opioid-related side effects were compared. Results: There was no difference in the 24-hour postoperative opioid consumption in morphine equivalents between the IV acetaminophen group (median, 11 mg; n=45) and the placebo group (median, 10.1 mg; n=41). No statistically significant difference of visual analog scale pain score was observed between 2 treatment groups. Patient satisfaction with overall postoperative pain management was significantly higher in the IV acetaminophen group than the placebo group on a 1 to 10 scale (8.1±0.4 vs. 6.9±0.4; P=0.03). There was no significant difference in secondary outcomes, including the incidence of opioid-related side effects. Conclusions: IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control.
AB - Background: Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy. Materials and Methods: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery. Total 24-hour opioid consumption, pain scores, satisfaction with overall pain management, time to meet postanesthesia care unit discharge criteria, and incidence of opioid-related side effects were compared. Results: There was no difference in the 24-hour postoperative opioid consumption in morphine equivalents between the IV acetaminophen group (median, 11 mg; n=45) and the placebo group (median, 10.1 mg; n=41). No statistically significant difference of visual analog scale pain score was observed between 2 treatment groups. Patient satisfaction with overall postoperative pain management was significantly higher in the IV acetaminophen group than the placebo group on a 1 to 10 scale (8.1±0.4 vs. 6.9±0.4; P=0.03). There was no significant difference in secondary outcomes, including the incidence of opioid-related side effects. Conclusions: IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control.
KW - : Acetaminophen
KW - craniotomy
KW - pain
UR - http://www.scopus.com/inward/record.url?scp=85048781554&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048781554&partnerID=8YFLogxK
U2 - 10.1097/ANA.0000000000000461
DO - 10.1097/ANA.0000000000000461
M3 - Article
C2 - 29117012
AN - SCOPUS:85048781554
SN - 0898-4921
VL - 30
SP - 231
EP - 236
JO - Journal of Neurosurgical Anesthesiology
JF - Journal of Neurosurgical Anesthesiology
IS - 3
ER -