Oral versus intravenous acetaminophen as a constituent of multimodal analgesia after coronary artery bypass graft surgery: A randomized, blinded trial
Background & Aim: This trial aimed to compare the pain relief and side effects of Oral Acetaminophen (OA) and Intravenous Acetaminophen (IVA) after CABG surgery.
Methods & Materials: This parallel-group, triple-blinded, randomized trial was conducted on 113 CABG patients from September 2017 through February 2018. The samples were selected through blocked randomization and allocated into two groups using computer-generated. The participants administered 1gr oral (OA group, n=57) or intravenous Acetaminophen (IVA group, n=56) every 6h for the first 24h following surgery; also, pain controlled in both group with Morphine multimodal analgesia strategy. Pain intensity measurement by VAS was followed after extubating the endotracheal tube at the 0, 1, 6, 12, 18 and 24 hours during the rest and deep breathing. The Morphine consumption and the incidence of nausea and vomiting in the first 24h were assessed. Data were analyzed using SPSS software and Chi-square, t-test, mixed ANOVA and ANCOVA test.
Results: The pain score in the IVA group was found to be statistically significantly lower than the OA group at rest (P<0.001) and during deep breathing (P<0.001) in the first 24h. There was no statistically significant difference between groups regarding the cumulative Morphine consumption (P=0.056). The use of IVA was associated with a reduction in frequencies of nausea and vomiting incidents (P=0.029).
Conclusion: Administration of IVA for the management of postoperative pain in CABG patients significantly reduced pain score and incidence of nausea and vomiting compared to OA. Any reduction in cumulative Morphine consumption did not accompany the lower pain.
2. Heikkilä K, Axelin A, Peltonen LM, Heimonen J, Anttila P, Viljanen T, Salakoski T, Salanterä S. Pain process of patients with cardiac surgery—Semantic annotation of electronic patient record data. Journal of clinical nursing. 2019 May;28(9-10):1555-67.
3. Macaire P, Ho N, Nguyen T, Nguyen B, Vu V, Quach C, Roques V, Capdevila X. Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery—A Patient-Matched, Controlled Before-and-After Study. Journal of cardiothoracic and vascular anesthesia. 2019 Jun 1;33(6):1659-67.
4. Micah S, Barolia R, Parpio Y, Kumar S, Sharif H. Factors Associated with Postoperative Pain among Patients after Cardiac Surgery in the Tertiary Care Teaching Hospital of Karachi, Pakistan. Pain research and treatment. 2019;2019.
5. Kayhan GE, Sanli M, Ozgul U, Kirteke R, Yologlu S. Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial. Journal of clinical anesthesia. 2018;50:5-11.
6. Pettersson PH, Jakobsson J, Öwall A. Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. Journal of cardiothoracic and vascular anesthesia. 2005 Jun 1;19(3):306-9.
7. Tyler MA, Lam K, Ashoori F, Cai C, Kain JJ, Fakhri S, Citardi MJ, Cattano D, Luong A. Analgesic effects of intravenous acetaminophen vs placebo for endoscopic sinus surgery and postoperative pain: a randomized clinical trial. JAMA Otolaryngology–Head & Neck Surgery. 2017 Aug 1;143(8):788-94.
8. Westrich GH, Birch GA, Muskat AR, Padgett DE, Goytizolo EA, Bostrom MP, Mayman DJ, Lin Y, YaDeau JT. Intravenous vs oral acetaminophen as a component of multimodal analgesia after total hip arthroplasty: a randomized, blinded trial. The Journal of Arthroplasty. 2019 Jul 1;34(7):S215-20.
9. Mamoun NF, Lin P, Zimmerman NM, Mascha EJ, Mick SL, Insler SR, Sessler DI, Duncan AE. Intravenous acetaminophen analgesia after cardiac surgery: A randomized, blinded, controlled superiority trial. The Journal of thoracic and cardiovascular surgery. 2016 Sep 1;152(3):881-9.
10. Jibril F, Sherif Sharaby AM, Wilby KJ. Intravenous versus oral acetaminophen for pain: systematic review of current evidence to support clinical decision-making. The Canadian journal of hospital pharmacy. 2015 May;68(3):238.
11. Jelacic S, Bollag L, Bowdle A, Rivat C, Cain KC, Richebe P. Intravenous acetaminophen as an adjunct analgesic in cardiac surgery reduces opioid consumption but not opioid-related adverse effects: a randomized controlled trial. Journal of cardiothoracic and vascular anesthesia. 2016 Aug 1;30(4):997-1004.
12. Fenlon S, Collyer J, Giles J, Bidd H, Lees M, Nicholson J, Dulai R, Hankins M, Edelman N. Oral vs intravenous paracetamol for lower third molar extractions under general anaesthesia: is oral administration inferior?. British journal of anaesthesia. 2013 Mar 1;110(3):432-7.
13. Johnson RJ, Nguyen DK, Acosta JM, O’Brien AL, Doyle PD, Medina-Rivera G. Intravenous Versus Oral Acetaminophen in Ambulatory Surgical Center Laparoscopic Cholecystectomies: A Retrospective Analysis. Pharmacy and Therapeutics. 2019 Jun;44(6):359-63.
14. Wasserman I, Poeran J, Zubizarreta N, Babby J, Serban S, Goldberg AT, Greenstein AJ, Memtsoudis SG, Mazumdar M, Leibowitz AB. Impact of intravenous acetaminophen on perioperative opioid utilization and outcomes in open colectomies: a claims database analysis. Anesthesiology. 2018 Jul;129(1):77-88.
15. Plunkett A, Haley C, McCoart A, Beltran T, Highland KB, Berry-Caban C, Lamberth S, Bartoszek M. A preliminary examination of the comparative efficacy of intravenous vs oral acetaminophen in the treatment of perioperative pain. Pain Medicine. 2017 Dec 1;18(12):2466-73.
16. Langford RA, Hogg M, Bjorksten AR, Williams DL, Leslie K, Jamsen K, Kirkpatrick C. Comparative plasma and cerebrospinal fluid pharmacokinetics of paracetamol after intravenous and oral administration. Anesthesia & Analgesia. 2016 Sep 1;123(3):610-5.
17. Singla NK, Parulan C, Samson R, Hutchinson J, Bushnell R, Beja EG, Ang R, Royal MA. Plasma and cerebrospinal fluid pharmacokinetic parameters after single‐dose administration of intravenous, oral, or rectal acetaminophen. Pain Practice. 2012 Sep;12(7):523-32.
18. Brett CN, Barnett SG, Pearson J. Postoperative plasma paracetamol levels following oral or intravenous paracetamol administration: a double-blind randomised controlled trial. Anaesthesia and intensive care. 2012 Jan;40(1):166-71.
19. Cattabriga I, Pacini D, Lamazza G, Talarico F, Di Bartolomeo R, Grillone G, Bacchi-Reggiani L. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. European Journal of Cardio-thoracic surgery. 2007 Sep 1;32(3):527-31.
20. Khalili G, Janghorbani M, Saryazdi H, Emaminejad A. Effect of preemptive and preventive acetaminophen on postoperative pain score: a randomized, double-blind trial of patients undergoing lower extremity surgery. Journal of clinical anesthesia. 2013 May 1;25(3):188-92.