Preoperative cesarean delivery intravenous acetaminophen treatment for postoperative pain control: a randomized double-blinded placebo control trial

Towers, Craig V.; Shelton, Sarah; Nes, Jaclyn van; Gregory, Emily J.; Liske, Emily; Smalley, A.; Mobley, Edward; Faircloth, Barbara; Fortner, Kimberly B.

doi:10.1016/j.ajog.2017.12.203

Cited by 20 publications

(15 citation statements)

References 13 publications

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“…A total of 145 studies were included, of which 126 were randomised controlled trials and 19 were systematic reviews and meta‐analyses (Fig. 1) [9–153]. The methodological quality assessments of the 126 randomised controlled trials included in the final qualitative analysis are summarised in online Supporting Information Table S1.…”

Section: Resultsmentioning

confidence: 99%

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PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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Section: Resultsmentioning

confidence: 99%

“…When paracetamol was administered pre‐operatively rather than at the end of surgery, only minor differences were noted [9]. In one study, rectal paracetamol was shown to be superior to pre‐operative oral paracetamol combined with i.v.…”

Section: Resultsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…Importantly, the use of preoperative IV paracetamol was not associated with an increased incidence of patient side effects [12,13] or adverse effects on the newborn. Administration of preoperative IV paracetamol did not result in elevated neonate cord blood levels [16] and there were no significant differences in mean 1 min and 5 min Apgar scores [11,13].…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, there are emerging concerns regarding prenatal paracetamol exposure and its potential effect on child neurodevelopment [23]. Although administration of preoperative IV paracetamol did not result in elevated neonate cord blood levels [16] and there were no significant differences in mean 1 min and 5 min Apgar scores [11,13], its long term effects on child neurodevelopment remain unknown.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Utility of Preoperative Intravenous Paracetamol for Post-Caesarean Analgesia

Loke

Yeo

et al. 2019

Medicina

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Background and objectives: Worldwide, the number of caesarean sections performed has increased exponentially. Some studies have reported better pain control and lower postoperative requirements for opioids when intravenous (IV) paracetamol was administered preoperatively. This meta-analysis thus aimed to investigate the utility of preoperative IV paracetamol for post-caesarean analgesia. Materials and Methods: By using the keywords (paracetamol OR acetaminophen) AND [cesarea* OR caesarea* OR cesaria* OR caesaria*], a systematic literature search was conducted using PubMed, Medline, Embase, Google Scholar and ClinicalTrials.gov databases for papers published in English between January 1, 1960 and March 1, 2019. Grey literature was searched as well. Results: Seven clinical trials were reviewed, while five randomized, placebo-controlled, double-blind studies were included in the final meta-analysis. Applying per-protocol analysis and a random-effects model, there was a significant reduction in postoperative opioid consumption and pain score in the group that received preoperative IV paracetamol, compared to placebo, as the standardized mean difference (SMD) were −0.460 (95% CI −0.828 to −0.092, p = 0.014) and −0.719 (95% CI: −1.31 to −0.13, p = 0.018), respectively. However, there was significant heterogeneity amongst the different studies included in the meta-analysis (I2 = 70.66%), perhaps owing to their diverse protocols. Some studies administered IV paracetamol 15 min before induction while others gave it before surgical incision. Conclusion: This is the first review on the topic. Overall, preoperative IV paracetamol has convincingly demonstrated useful opioid-sparing effects and it also appears safe for use at the time of delivery. It should be considered as a component of an effective multimodal analgesic regimen. Future studies could be conducted on other patient groups, e.g., those with multiple comorbidities or chronic pain disorders, and further delineate the optimal timing to administer the drug preoperatively.

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“…18 Two additional randomized studies in patients undergoing cesarean delivery differed in their findings when a single dose of IV acetaminophen was compared to placebo. 19,20 Patients studied after hysterectomy received 24 hours of IV acetaminophen postoperatively and were compared to those receiving placebo. There was no significant difference between groups in terms of pain scores or postoperative opioid utilization.…”

Section: Gynecologic Surgerymentioning

confidence: 99%

Review of Intravenous Acetaminophen for Analgesia in the Postoperative Setting

Tompkins

DiPasquale

Segovia

et al. 2021

The American Surgeon

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Background Acetaminophen is a non-opioid analgesic commonly utilized for pain control after several types of surgical procedures. Methods This scoping primary literature review provides recommendations for intravenous (IV) acetaminophen use based on type of surgery. Results Intravenous acetaminophen has been widely studied for postoperative pain control and has been compared to other agents such as NSAIDs, opioids, oral/rectal acetaminophen, and placebo. Some of the procedures studied include abdominal, gynecologic, orthopedic, neurosurgical, cardiac, renal, and genitourinary surgeries. Results of these studies have been conflicting and largely have not shown consistent clinical benefit. Conclusion Overall, findings from this review did not support the notion that IV acetaminophen has significant efficacy for postoperative analgesia. Given the limited clinical benefit of IV acetaminophen, especially when compared to the oral or rectal formulations, use is generally not justifiable.

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Preoperative cesarean delivery intravenous acetaminophen treatment for postoperative pain control: a randomized double-blinded placebo control trial

Cited by 20 publications

References 13 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

A Meta-Analysis of the Utility of Preoperative Intravenous Paracetamol for Post-Caesarean Analgesia

Review of Intravenous Acetaminophen for Analgesia in the Postoperative Setting

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