BACKGROUND AND PURPOSE:

• Turner et al. (Obstetrics & Gynecology, 2019) assessed the effect of preoperative IV acetaminophen as a single-agent preemptive analgesic on pain scores following pelvic organ prolapse (POP) surgery

METHODS:

• Double-blind placebo-controlled multicenter trial (RCT)
  • Women undergoing POP surgery
  • Minimally invasive surgery (vaginal, laparoscopic or robotic)
• Women received (10–30 minutes before incision) either
  • IV acetaminophen (1,000 mg)
  • Preoperative saline
• Primary outcome: Change from baseline in patient-reported visual analog scale pain scores at 24 hours after surgery
• Secondary outcomes included
  • Narcotic use (morphine milligram equivalents) | Patient satisfaction| Quality of life (QOL) using validated questionnaires on postoperative days 1 and 7 | Overall side effects

RESULTS

• 202 women enrolled
  • IV acetaminophen 102 | Placebo 100  
  • 162 had primary outcomes analyzed
• Procedure stratification
  • IV acetaminophen: Vaginal n=52 | Laparoscopic n=50
  • Placebo: Vaginal n=49 | Laparoscopic n=51
• Demographics
  • Mean age: 66 years
  • Caucasian: 96%
  • Postmenopausal: 96%
• Comparing acetaminophen to placebo, there were not differences in mean change from baseline pain scores at 24 hours overall or stratified by procedure
  • Overall 25±26 vs 21±24 mm
  • Vaginal 29±28 vs 21±23 mm
  • Laparoscopic 20±26 vs 21±25 mm
  • Nor were changes at other time points up until 24 hours
• Comparing acetaminophen to placebo, there were no differences in 24-hour morphine milligram equivalent narcotic use
  • Overall 38±25 vs 40±25 mg
  • Vaginal 32±24 vs 33±25 mg
  • Laparoscopic 45±24 vs 47±24 mg
• No differences were seen in patient satisfaction, QOL, or side effects (nausea, drowsiness, itching or dizziness)
  • Urinary retention was higher in acetaminophen (vaginal arm) of 59.2% vs 33.3% in placebo (P=0.01)
  • There was no difference in return of bowel function

CONCLUSION:

• Preoperative IV acetaminophen did not reduce pain scores or opioid use following prolapse repair
• Role as the only preemptive pain medication is not warranted based on this study

Learn More – Primary Sources:

Intravenous Acetaminophen Before Pelvic Organ Prolapse Repair: A Randomized Controlled Trial

Related ObG Topics:

Evidence-Based Gynecologic Surgery Best Practices: The AHRQ Safety Program

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

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