title: Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The authors hypothesized that intravenous acetaminophen as an adjunct analgesic would significantly decrease 24-hour postoperative opioid consumption.
  
  
  METHODS
  Double-blind, randomized, placebo-controlled trial.
  
  
  METHODS
  A single academic medical center.
  
  
  METHODS
  The study was comprised of 68 adult patients undergoing cardiac surgery.
  
  
  METHODS
  Patients were assigned randomly to receive either 1,000 mg of intravenous acetaminophen or placebo immediately after anesthesia induction, at the end of surgery, and then every 6 hours for the first 24 hours in the intensive care unit, for a total of 6-1,000 mg doses.
  
  
  RESULTS
  The primary outcome was 24-hour postoperative opioid consumption. The secondary outcomes included 48-hour postoperative opioid consumption, incisional pain scores, opioid-related adverse effects, length of mechanical ventilation, length of intensive care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48 hours postoperatively. The mean±standard deviation postoperative 24-hour opioid consumption expressed in morphine equivalents was significantly less in the acetaminophen group (45.6±29.5 mg) than in the placebo group (62.3±29.5 mg), representing a 27% reduction in opioid consumption (95% CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and opioid-related adverse effects between the 2 groups. A significantly greater number of patients in the acetaminophen group responded "very much" and "extremely well" when asked how their overall pain experience met their expectation (p = 0.038).
  
  
  CONCLUSIONS
  The administration of intravenous acetaminophen during cardiac surgery and for the first 24 hours postoperatively reduced opioid consumption and improved patient satisfaction with their overall pain experience but did not reduce opioid side effects.
authors: Department of Anesthesiology and Pain Medicine. Electronic address: sjelacic@uw.edu.
authors: Srdjan
authors: S
authors: Jelacic
authors: Department of Anesthesiology and Pain Medicine.
authors: Laurent
authors: L
authors: Bollag
authors: Department of Anesthesiology and Pain Medicine.
authors: Andrew
authors: A
authors: Bowdle
authors: Department of Anesthesiology and Pain Medicine.
authors: Cyril
authors: C
authors: Rivat
authors: Biostatistics, University of Washington School of Public Health, Seattle, WA.
authors: Kevin C
authors: KC
authors: Cain
authors: Department of Anesthesiology and Pain Medicine.
authors: Philippe
authors: P
authors: Richebe
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000494:pharmacology*; D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000494:pharmacology*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006930:Hyperalgesia; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen
keywords: analgesia; cardiac surgery; intravenous acetaminophen