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Grand Rounds

How Well Does IV Acetaminophen Control Post-Op Cesarean Pain?

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PURPOSE:

  • Reducing narcotics postoperatively is a national and professional initiative
    • Multimodal pain management can help achieve this goal
  • IV acetaminophen dosing similar to oral: 1 g every 6 hours for a maximum dose of 4 g over 24 hours
  • Data on the use of IV acetaminophen in obstetrical care is limited
  • Altenau et al. (AJOG, 2017) designed an RCT to investigate whether the use of IV acetaminophen following routine cesarean section reduced the need for narcotics post operatively

METHODS:

  • Randomized, double-blind, placebo-controlled trial (2104-2016)
  • Scheduled cesarean section ≥ 37 weeks gestation
  • Eligibility: ≥ 18 years, singleton, planned regional anesthesia with intrathecal morphine sulfate and pfannenstiel skin incision
  • Drug administered preoperatively within 30–60 minutes of skin incision followed by IV doses every 8 hours for a total of 6 doses, over 48 hours (daily dosing of acetaminophen of 3 g)
  • Breakthrough pain
    • Mild to moderate pain: oral ibuprofen up to 800 mg as needed every 8 hours
    • Moderate to severe pain: oral oxycodone 5–10 mg as needed every 4 hours

RESULTS:

  • Total of 133 patients consented
    • 104 completed (57 intervention group; 47 placebo arm)
    • No differences in baseline demographics
  • When comparing IV acetaminophen to controls
    • Oral narcotic medications consumed by was significantly reduced (47 mg vs 65 mg of oxycodone; P = .034)
    • Amount of ibuprofen not statistically different
    • Pain scores not significantly different
    • Narcotic side effects (nausea/emesis, respiratory depression, constipation) were not statistically different

CONCLUSION:

  • Use of IV acetaminophen during the recovery period following cesarean section significantly decreased the total amount of narcotics
  • The authors state that consideration should be given to routinely incorporating IV acetaminophen into post–cesarean multimodal pain management

Learn More – Primary Sources:

Randomized controlled trial of intravenous acetaminophen for postcesarean delivery pain control

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Related ObG Topics:

Fixed-Interval or On-Demand Treatment Better for C-Section Pain?
FDA Restricts Codeine and Tramadol in Children and Breastfeeding Mothers – ACOG SMFM ABM Respond 
ACOG & SMFM: Acetaminophen Use and Safety in Pregnancy
Preemptive Analgesia to Control Postop Hysterectomy Pain: The SGS Clinical Guidelines
Are NSAIDs (Single Dose) Effective at Reducing Perineal Pain Post Childbirth?

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