A first-line multimodal intravenous (IV) acetaminophen (APAP) protocol reduced opioid use in older patients with polytrauma in the perioperative setting. These findings were published in the Journal of Surgical Research.

This retrospective analysis was conducted at Nassau University Medical Center in the East Meadow, New York. A pain protocol was implemented in 2015 at the study site, in which 1 gram IV APAP was administered every 6 hours for perioperative pain management coupled with 375 mg twice daily naproxen, 50-100 mg tramadol every 6 hours as needed, and 2-4 mg IV morphine every 4 hours as needed.

Patients (N=121) undergoing orthopedic surgery for trauma in 2014 (n=22) or 2017 (n=99) were evaluated for postoperative pain and opioid consumption. Outcomes prior to and after the pain protocol was implemented were compared.


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Patients in the historical and experimental cohort were aged median 80 (interquartile range [IQR], 68.0-89.5) and 83.5 (IQR, 72.7-90.0) years, 68.2% and 73.7% were women, injury severity scores were 9.0 (IQR, 9.0-9.51) and 9.0 (IQR, 9.0-10.0), and 90.9% and 91.9% were undergoing lower extremity surgery, respectively.

The IV APAP protocol was associated with decreased opioid consumption during the first 24 hours (mean, 20.9 vs 4.3 morphine milligram equivalent [MME]; P <.001) and between 24 and 48 hours (mean, 19.8 vs 2.1 MME; P <.001) after surgery. Fewer patients in the IV APAP cohort received opioids during the first postoperative 24 (81.8% vs 28.2%; P <.001) and 24 to 48 (63.6% vs 9.1%; P <.001) hours.

The IV APAP protocol was associated with decreased hospital stay (median, 6 vs 5 days; P =.013). No differences in length of stay in the intensive care unit (P =.846) or hospital release location (P =.952) were observed.

No significant differences were observed for numeric pain scale (NRS) scores at 24 hours (mean, 1.8 vs 2.0; P =.879) or between 24 and 48 hours (mean, 1.8 vs 2.1; P =.405) among the historical and experimental cohorts, respectively.

Similar trends were observed among the subgroup of patients aged ≥74 years, with the exception that difference in hospital stay was attenuated in this subset of patients (P =.057).

This study was limited by its retrospective design, in which pain scores were based on documentation by the intensive care unit staff and were not specifically protocolized for this study.

These data indicated that implementation of a first-line IV APAP therapy among patients who underwent orthopedic surgery due to trauma decreased opioid consumption and hospital stay but the protocol had little effect on pain scores.

Reference

Shafeeq H, DiGiacomo JC, Sookraj KA, et al. Perioperative multimodal pain management approach in older adults with polytrauma. J Surg Res. 2022;275:96-102. doi:10.1016/j.jss.2021.12.028