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

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 

SMFM Releases Statement on Acetaminophen Use in Pregnancy

Preemptive Analgesia to Control Postop Hysterectomy Pain: The SGS Clinical Guidelines

Are NSAIDs (Single Dose) Effective at Reducing Perineal Pain Post Childbirth?