Clinical and Economic Evidence for Intravenous Acetaminophen

Abstract

Intravenous acetaminophen received United States Food and Drug Administration approval in November 2010 for the management of mild-to-moderate pain, management of moderate-to-severe pain with adjunctive opioid analgesics, and reduction of fever. Although intravenous acetaminophen generally improved pain relief and demonstrated opioid-sparing effects compared with placebo, it did not consistently reduce the frequency of opioid-related adverse events (e.g., postoperative nausea and vomiting). The safety and efficacy of intravenous acetaminophen as an antipyretic agent have been documented in adults and children; however, its cost is several-fold higher than that of the oral and rectal formulations. Although use of intravenous acetaminophen has reduced other postoperative resource utilization (e.g., hospital length of stay) in some studies outside the United States in patients undergoing abdominal surgery, a full economic evaluation in the United States has yet to be undertaken. In addition, its administration time (15-min infusion) and packaging (glass, single-use vial) have the potential to adversely affect patient flow in the postanesthesia care unit, create burden on patient care units, and lead to drug waste. Furthermore, 1 g of intravenous acetaminophen is formulated in 100 ml of solution, which may be an issue for patients with fluid restrictions. Given the clinical and economic evidence currently available, intravenous acetaminophen should not replace oral or rectal acetaminophen, but its use may be considered in a limited number of patients who cannot receive drugs orally and rectally and who cannot tolerate other parenteral nonopioid analgesic or antipyretic agents.

Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study

“…Moreover, meta-analyses demonstrating some benefit of intravenous APAP acknowledge the limited quality of evidence, while they also may not reflect clinical practice as comparisons are made with placebo 7 8. Of additional concern is the relatively high cost of intravenous APAP in the USA, compared with the oral formulation,9 which when used in high-volume surgeries such as TJA would amount to a substantial cost burden 10. Therefore, in the absence of robust, pragmatic data on this subject, using US national claims data we aimed to (1) provide an overview of intravenous APAP utilization patterns after TJA in the USA, (2) evaluate the impact of intravenous APAP on opioid utilization, length and cost of hospitalization, and opioid-related complications, and (3) compare how this relates to oral APAP.…”

Opioid Use in Knee Arthroplasty After Receiving Intravenous Acetaminophen

“…Effective pain management is an important component of postoperative care . Opioids are well established as the primary treatment for postoperative pain . Multimodal analgesia, which has been more widely used in recent years for postoperative pain, may reduce opioid use.…”

Pain Management After Thoracic Surgery

“…26 Although effective in many situations, drawbacks include the slow, recommended administration in 100 mL of saline solution. 26 Although effective in many situations, drawbacks include the slow, recommended administration in 100 mL of saline solution.…”