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Grand Rounds

Does Preop IV Acetaminophen Reduce Pain following Pelvic Organ Prolapse Surgery?

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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

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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

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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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