Perioperative intravenous acetaminophen and NSAIDs.

BACKGROUND

Unrelieved postoperative pain may result in pain/suffering, as well as multiple physiological and psychological consequences (e.g., splinting, impaired gastrointestinal motility/ileus, and impaired wound healing) which may adversely affect perioperative outcomes and contribute to increased length of stay. Multimodal or balanced analgesia, utilizing regional analgesic techniques (where possible) and nonopioid analgesics appear to represent a viable strategy to decrease systemic opioid consumption and improve postoperative analgesia. The use of multimodal analgesic strategies may result in reduced frequency and severity of unwanted opioid-related adverse effects, better clinically meaningful pain relief, diminished opioid consumption, and an overall improvement of patient satisfaction as well as health outcomes (e.g., earlier ambulation and discharge).

OBJECTIVES

Review key aspects of intravenous (i.v.) acetaminophen (APAP) use in the postoperative setting.

DESIGN

Focused literature review.

RESULTS

Intravenous APAP is safe, effective for mild-to-moderate postoperative pain, well-tolerated, and has a very favorable side effect profile with no clearly demonstrated clinically significant drug-drug interactions. It does not exhibit any significant effects on platelet aggregation and therefore may be the preferred nonopioid analgesic when surgical bleeding is an issue.

CONCLUSION

The i.v. formulation of APAP represents a safe and effective first-line analgesic agent for the treatment of acute mild-to-moderate pain in the perioperative setting when oral agents may be impractical or when rapid onset with predictable therapeutic dosing is required.