Association between intravenous acetaminophen and reduction in intraoperative opioid consumption during transsphenoidal surgery for pituitary tumors

Banerjee, Upasana; Hagan, Katherine; Bhavsar, Shreyas; Grasu, Roxana; Dang, Anh; McCutcheon, Ian E.; Suárez, Miguel; Gottumukkala, Vijaya; Cata, Juan P.

doi:10.4103/joacp.joacp_276_17

Cited by 7 publications

(7 citation statements)

References 25 publications

(32 reference statements)

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“…Previous studies that evaluated the effects of intravenous acetaminophen on postoperative pain and opioid consumption reported mixed results. Some studies have reported that intravenous acetaminophen spares opioid use and reduces postoperative pain . A recent study in elderly patients recovering from cardiac surgery reported that intravenous acetaminophen decreased opioid consumption and reduced delirium .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported that intravenous acetaminophen spares opioid use and reduces postoperative pain. 6,[18][19][20] A recent study in elderly patients recovering from cardiac surgery reported that intravenous acetaminophen decreased opioid consumption and reduced delirium. 21 .…”

Section: Discussionmentioning

confidence: 99%

“…The second is that its efficacy as an analgesic remains unclear. Several small trials and a large observational analysis suggest that acetaminophen provides relatively little opioid sparing, even by the limited standards of nonopioid analgesic adjuvants . A consequence is that acetaminophen may not spare opioids sufficiently to reduce the risk of opioid-related respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

“…Several small trials and a large observational analysis suggest that acetaminophen provides relatively little opioid sparing, even by the limited standards of nonopioid analgesic adjuvants. [4][5][6][7][8][9] A consequence is that acetaminophen may not spare opioids sufficiently to reduce the risk of opioid-related respiratory depression. Previous studies did not demonstrate significant reductions in opioid-related adverse events, mostly because sample sizes were inadequate and complications were poorly monitored.…”

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confidence: 99%

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Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

Turan

Essber

Saasouh

et al. 2020

JAMA

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for the FACTOR Study Group IMPORTANCE Opioid-induced ventilatory depression and hypoxemia is common, severe, and often unrecognized in postoperative patients. To the extent that nonopioid analgesics reduce opioid consumption, they may decrease postoperative hypoxemia.OBJECTIVE To test the hypothesis that duration of hypoxemia is less in patients given intravenous acetaminophen than those given placebo. DESIGN, SETTING, AND PARTICIPANTS Randomized, placebo-controlled, double-blind trial conducted at 2 US academic hospitals among 570 patients who were undergoing abdominal surgery, enrolled from February 2015 through October 2018 and followed up until February 2019.INTERVENTIONS Participants were randomized to receive either intravenous acetaminophen, 1 g (n = 289), or normal saline placebo (n = 291) starting at the beginning of surgery and repeated every 6 hours until 48 postoperative hours or hospital discharge, whichever occurred first. MAIN OUTCOMES AND MEASURESThe primary outcome was the total duration of hypoxemia (hemoglobin oxygen saturation [SpO 2 ] <90%) per hour, with oxygen saturation measured continuously for 48 postoperative hours. Secondary outcomes were postoperative opioid consumption, pain (0-10-point scale; 0: no pain; 10: the most pain imaginable), nausea and vomiting, sedation, minimal alveolar concentration of volatile anesthetic, fatigue, active time, and respiratory function.RESULTS Among 580 patients randomized (mean age, 49 years; 48% women), 570 (98%) completed the trial. The primary outcome, median duration with SpO 2 of less than 90%, was 0.7 (interquartile range [IQR], 0.1-5.1) minutes per hour among patients in the acetaminophen group and 1.1 (IQR, 0.1-6.6) minutes per hour among patients in the placebo group (P = .29), with an estimated median difference of −0.04 (95% CI,−0.18 to 0.11) minutes per hour. None of the 8 secondary end points differed significantly between the acetaminophen and placebo groups. Mean pain scores within initial 48 postoperative hours were 4.2 (SD, 1.8) in the acetaminophen group and 4.4 (SD, 1.8) in the placebo group (difference, −0.28; 95% CI, -0.71 to 0.15); median opioid use in morphine equivalents was 50 mg (IQR, 18-122 mg) and 58 mg (IQR, 24-151 mg) , respectively, with a ratio of geometric means of 0.86 (95% CI, 0.61-1.21).CONCLUSIONS AND RELEVANCE Among patients who underwent abdominal surgery, use of postoperative intravenous acetaminophen, compared with placebo, did not significantly reduce the duration of postoperative hypoxemia over 48 hours. The study findings do not support the use of intravenous acetaminophen for this purpose.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

Turan

Essber

Saasouh

et al. 2020

JAMA

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“…115,116 Surgical stimulation of the trigeminal nerve supplying the nasal cavity and dura mater may lead to significant postoperative pain in TSA patients. 30,117 Pain control therefore remains an important element of optimal surgical care for transsphenoidal surgery.…”

Section: Analgesiamentioning

confidence: 99%

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery

Barrette

Douglas

Chorath

et al. 2022

Journal of Craniofacial Surgery

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Objective: To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery. Methods: The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed. Results: The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population. Conclusion: Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.

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Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care

Barrette,

Cohen,

Chao

et al. 2024

World j. otorhinolaryngol.-head neck surg.

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ObjectivesEnhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.Data SourcesA search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included “endoscopic sinus surgery,” “sinus surgery,” “FESS,” and “ESS” for each area of intervention. Where applicable, the authors considered high‐level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.MethodsStudies received grades of “low,” “moderate,” or “high” quality evidence based on the Oxford Centre for Evidence‐Based Medicine criteria. Each intervention was subsequently assigned a grade of “strong,” “weak,” or “conditional” based on the available evidence.ResultsStrong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.ConclusionA comprehensive ERAS protocol for ESS can include a variety of high yield, evidence‐based interventions that would likely improve surgical outcomes and patient satisfaction.

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Association between intravenous acetaminophen and reduction in intraoperative opioid consumption during transsphenoidal surgery for pituitary tumors

Cited by 7 publications

References 25 publications

Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery

Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care

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