Schwenk Eric S, Ferd Polina, Torjman Marc C, Li Chris J, Charlton Alex R, Yan Vivian Z, McCurdy Michael A, Kepler Christopher K, Schroeder Gregory D, Fleischman Andrew N, Issa Tariq
Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Reg Anesth Pain Med. 2025 Jun 10;50(6):483-488. doi: 10.1136/rapm-2024-105386.
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.
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.
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.
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.
NCT04574778.
随着门诊脊柱手术的增加，高效恢复和出院变得至关重要。多模式镇痛优于单纯使用阿片类药物。对乙酰氨基酚是多模式方案的核心组成部分，静脉和口服形式均有使用。虽然有人吹捧静脉注射对乙酰氨基酚有一些优势，但在门诊脊柱手术中缺乏以患者为中心结局的前瞻性研究。存在显著的成本差异。我们假设静脉注射对乙酰氨基酚会减少阿片类药物的使用并带来更好的恢复。
接受门诊脊柱手术的患者被随机分为术前口服安慰剂并术中静脉注射对乙酰氨基酚组或术前口服对乙酰氨基酚组。所有患者均接受全身麻醉和多模式镇痛。主要结局是从到达麻醉后护理单元（PACU）开始的24小时阿片类药物使用量，以静脉注射吗啡毫克当量（MME）计。次要结局包括疼痛、恢复质量（QoR）-15评分、术后恶心和呕吐、恢复时间，以及疼痛灾难化、QoR-15和疼痛之间的相关性。
最终分析共纳入82例患者。两组的人口统计学特征相似。对于主要结局，两组的24小时MME中位数无差异（12.6（4.0，27.1）mg对12.0（4.0，29.5）mg，p = 0.893）。术后疼痛评分、PACU的MME、QoR-15评分和恢复时间均无差异。Spearman相关性分析显示术后阿片类药物使用与QoR-15之间存在中度负相关。
在门诊脊柱手术患者中，静脉注射对乙酰氨基酚并不优于口服形式。这并不支持常规使用更昂贵的静脉注射形式来改善恢复和加速出院。
NCT04574778。
