Cost‐effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery

Chidambaran, Vidya; Subramanyam, Rajeev; Ding, Lili; Sadhasivam, Senthilkumar; Geisler, Kristie J; Stubbeman, Bobbie L.; Sturm, Peter; Jain, Viral V.; Eckman, Mark H.

doi:10.1111/pan.13329

Cited by 25 publications

(14 citation statements)

References 34 publications

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“…The lack of differences in opioid use at these points of the perioperative pathway is likely due to providers giving standard doses on induction of anesthesia, as well as throughout the case, and reflex prescribing when a patient requests an analgesic or reports an elevated pain score to the PACU providers. This is a point of needed improvement in our ERAS protocol, and we encourage others developing perioperative analgesic protocols to consider an algorithm for addressing pain in the PACU and whether or not they will give recommendations for intraoperative analgesic administration 13‐16 …”

Section: Discussionmentioning

confidence: 99%

Opioid reduction in ambulatory thyroid and parathyroid surgery after implementing enhanced recovery after surgery protocol

et al. 2021

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Background Opioid abuse is widespread in the United States and the risk for chronic use is increased in surgical patients, including patients with thyroid and parathyroid. Methods Records for 171 patients prior to and 67 patients following implementation of an enhanced recovery after surgery (ERAS) protocol for ambulatory thyroid/parathyroid surgeries were reviewed. The ERAS included superficial cervical plexus block, multimodal premedication, and postoperative reliance on acetaminophen and ibuprofen with judicious prescribing of opioids. Results Post‐ERAS patients were prescribed a mean 72 morphine milligram equivalents (MME); pre‐ERAS patients were prescribed a mean 163 MME (p < 0.001). 97.1% of pre‐ERAS patients were prescribed opioids with 91.1% filled; 68.7% of post‐ERAS study patients were prescribed opioids with 84.8% filled. Conclusion Implementation of ERAS and focus on prescribing practices decreased the MME prescribed and used for ambulatory thyroid and parathyroid surgery. Future steps include increased patient education and tracking pain scores and medication utilization out of hospital.

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Section: Discussionmentioning

confidence: 99%

Opioid reduction in ambulatory thyroid and parathyroid surgery after implementing enhanced recovery after surgery protocol

et al. 2021

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“…LOS after PAO was shown in prior studies to be 4–5 days [ 24 ], similar to what we found in the EP protocol (4.38 ± 1.02 days). In our previous studies investigating the cost-effectiveness of analgesic regimens after spine fusion, we found that average daily in-patient costs in an orthopedic ward ≈ $2654 (direct costs≈$1639; indirect costs≈$1015) [ 25 ]. Thus, MM-FICNB protocol, associated with significantly decreased length of stay (2.88 ± 0.72 days) has the potential to significantly improve value-based care, decreasing cost without affecting analgesia.…”

Section: Discussionmentioning

confidence: 99%

Pragmatic comparative effectiveness study of multimodal fascia iliaca nerve block and continuous lumbar epidural-based protocols for periacetabular osteotomy

Albertz

Whitlock

Fang

et al. 2020

Journal of Hip Preservation Surgery

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Perioperative pain management protocols have a significant impact on early surgical outcomes and recovery. We hypothesized that multimodal protocol including fascia iliaca compartment nerve block (MM-FICNB) would decrease the length of hospital stay (LOS) by facilitating earlier mobilization, without compromising analgesia, compared to a traditional lumbar epidural-based protocol (EP). Demographics/comorbidities, surgical/block characteristics and perioperative pain/mobilization data were collected from a prospectively recruited MM-FICNB group (N = 16) and a retrospective EP cohort (N = 16) who underwent PAO using similar surgical techniques, physical therapy/discharge criteria. Association of MM-FICNB group with LOS (primary outcome), postoperative pain, postoperative opioid requirements in morphine equivalent rates (MER) (mcg/kg/h) and time to complete physical therapy were tested using multivariable and survival regression. Patient and surgical characteristics were similar between groups. Median time for FICNB performance was significantly less than epidural (6 versus 15 min; P < 0.001). LOS was significantly decreased in the MM-FICNB group (2.88 ± 0.72 days) compared to the EP group (4.38 ± 1.02 days); P < 0.001. MM-FICNB group had significantly lower MER on POD1 (P = 0.006) and POD2 (P < 0.001), with similar pain scores on all POD. MM-FICNB group was associated with decreased LOS and earlier mobilization (P < 0.001) by covariate-adjusted multivariate regression. Cox proportional hazard regression model showed MM-FICNB subjects had 63 (95% CI 7–571, P < 0.001) times the chance of completing physical therapy goals, compared to EP. Compared to EP, MM-FICNB protocol allowed earlier mobilization and decreased post-surgical hospitalization by 1.5 days, without compromising analgesia, with important implications for value-based healthcare and cost-effectiveness.

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“…Addition of paracetamol to an NSAID in our study was associated with faster oral fluid tolerance, particularly in patients given morphine-PCA. Faster oral intake with the combination of acetaminophen–ketorolac–opioids over opioids alone and opioids–acetaminophen was recently reported in an observational study of adolescents after scoliosis surgery [26]. However, no comparison was provided with the opioids–ketorolac group.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Paracetamol in Adjunct to Intravenous Ketoprofen for Postoperative Pain in Children Undergoing General Surgery: A Double-Blinded Randomized Study

Rugytė

Gudaitytė

2019

Medicina

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Background and objectives: The combination of non-steroidal anti-inflammatory drugs and paracetamol is widely used for pediatric postoperative pain management, although the evidence of superiority of a combination over either drug alone is insufficient. We aimed to find out if intravenous (i.v.) paracetamol in a dose of 60 mg kg−1 24 h−1, given in addition to i.v. ketoprofen (4.5 mg kg−1 24 h−1), improves analgesia, physical recovery, and satisfaction with postoperative well-being in children and adolescents following moderate and major general surgery. Materials and Methods: Fifty-four patients were randomized to receive either i.v. paracetamol or normal saline as a placebo in adjunct to i.v. ketoprofen. For rescue analgesia in patients after moderate surgery, i.v. tramadol (2 mg kg−1 up two doses in 24 h), and for children after major surgery, i.v. morphine-patient-controlled analgesia (PCA) were available. The main outcome measure was the amount of opioid consumed during the first 24 h after surgery. Pain level at 1 and over 24 h, time until the resumption of normal oral fluid intake, spontaneous urination after surgery, and satisfaction with postoperative well-being were also assessed. Results: Fifty-one patients (26 in the placebo group and 25 in the paracetamol group) were studied. There was no difference in required rescue tramadol doses (n = 11 in each group) or 24-h morphine consumption (mean difference (95% CI): 0.06 (–0.17; 0.29) or pain scores between placebo and paracetamol groups. In patients given morphine-PCA, time to normal fluid intake was faster in the paracetamol than the placebo subgroup: median difference (95% CI): 7.5 (1.3; 13.7) h, p = 0.02. Parental satisfaction score was higher in the paracetamol than the placebo group (mean difference: –1.3 (–2.5; –0.06), p = 0.04). Conclusions: There were no obvious benefits to opioid requirement or analgesia of adding regular intravenous paracetamol to intravenous ketoprofen in used doses. However, intravenous paracetamol may contribute to faster recovery of normal functions and higher satisfaction with postoperative well-being.

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Cost‐effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery

Abstract: Intravenous acetaminophen with or without ketorolac reduced opioid consumption, opioid-related adverse effects, length of stay, and thereby cost of care following idiopathic scoliosis in adolescents compared with opioids-alone postoperative analgesia strategy.

Cited by 25 publications

References 34 publications

Opioid reduction in ambulatory thyroid and parathyroid surgery after implementing enhanced recovery after surgery protocol

Opioid reduction in ambulatory thyroid and parathyroid surgery after implementing enhanced recovery after surgery protocol

Pragmatic comparative effectiveness study of multimodal fascia iliaca nerve block and continuous lumbar epidural-based protocols for periacetabular osteotomy

Intravenous Paracetamol in Adjunct to Intravenous Ketoprofen for Postoperative Pain in Children Undergoing General Surgery: A Double-Blinded Randomized Study

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