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Intravenous versus Rectal Acetaminophen as an Adjunct to Multimodal Analgesia after Cesarean Delivery
Abstract Number: S2B-4
Abstract Type: Original Research
The combination of acetaminophen with non-steroidal anti-inflammatory drugs (NSAIDs) has been shown to decrease opioid consumption postoperatively by 38-57%.1,2 However, few studies have compared intravenous (IV) to rectal (PR) acetaminophen administration, in evaluating opioid consumption after spinal anesthesia for cesarean delivery (CD).
In this study we reviewed 110 records in the months from October 2017- January 2018. After spinal anesthesia with bupivacaine (0.75%), 1.6-1.8 mL, fentanyl 10 mcg, and preservative free morphine 0.1-0.15 mg, patients received either PR (975 mg) acetaminophen after neuraxial anesthesia, or IV acetaminophen (1 g) after delivery. IV ketorolac 30 mg was also administered during closure of fascia. After CD, ketorolac 30 mg IV q 6hrs, and acetaminophen 650 mg PO q 6hrs were ordered for the next 24 hrs. Fifty-eight patients were excluded since they had receive a transverse abdominis plane block, did not receive intrathecal morphine, had a history of chronic or recent opioid/anxiolytic use, and/or diagnosis of preeclampsia. Electronic medical records were reviewed, and the following data was collected: age, height, weight, BMI, gravity, parity, gestational age, pain visual analogue scores (VAS) at 6, 12, 18, 24 hrs, time to first opioid request, and morphine equivalent dose at 6, 12, 18, 24 hrs. Two-sample t-test and Wilcoxon rank sum test were used for statistical analysis, with a two-sided p < 0.05 considered significant.
Demographic summary and data analysis of primary outcome (opioid consumption at 24 hr) are summarized in Table 1. No statistical difference was noted for visual analogues scores, nor morphine equivalents at 6, 12, 18, 24 hrs.
Our results suggest that there is no difference in opioid consumption or visual analogue scores at 6, 12, 18, 24 hrs, when comparing the effectiveness of a single dose PR versus IV acetaminophen as part of a multimodal approach for post-cesarean analgesia. A randomized controlled trial needs to be designed to investigate whether the cost of IV acetaminophen (~$38 per dose) is justifiable given no significant difference in opioid consumption in our small cohort study. Future studies designed to evaluate plasma levels of PR and IV acetaminophen after neuraxial anesthesia, and a cost-analysis study between the different routes of administration, should follow.
1 Reg. Anesth and Pain Med 2001
2 Int J Obstet Anesth 2008