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Intravenous Acetaminophen May Not Lower Opioid Use in Spine Patients

New York, NY—April 4, 2018

Intravenous acetaminophen may not decrease opioid utilization or lower opioid-related risks in the postoperative setting – a key argument against its routine inclusion in analgesic regimens, according to a study published in Anesthesia and Analgesia.

In pill form, acetaminophen is a common over-the-counter medication used to treat minor aches and pains. Its intravenous use, however,  was only relatively recently approved by the FDA in 2010, explained principal investigator Stavros G. Memtsoudis, MD, PhD, anesthesiologist and senior scientist at Hospital for Special Surgery (HSS).

Since its approval, intravenous acetaminophen use has been widely adopted as part of a multimodal analgesic approach meant to lower overall opioid consumption and decrease adverse outcomes associated with those medications.  It is also an expensive drug, adds Dr. Memtsoudis, who previously published research into its pricing in a 2015 issue of Regional Anesthesiologists and Pain Medicine. Additionally, there is not much data to back up the efficacy of intravenous acetaminophen in treating acute pain caused by orthopedic procedures in comparison to other more established and less costly alternatives.

These factors –  the limited data demonstrating its analgesic effectiveness, its high cost and its rapidly expanding use – spurred the researchers to investigate the impact intravenous acetaminophen has on postoperative pain control specifically in spine surgeries that have traditionally required high opioid use to treat postoperative pain.

Using data from 117,269 lumbar/lumbosacral spinal fusion patients enrolled in the Premier Healthcare Database from 2011 through 2014, the investigators evaluated an association between intravenous acetaminophen use with opioid use and opioid-related complications in surgeries that usually require a high dose of opioid medication.

The research team found that in 19 percent (n=22,208) of cases, at least one dose of intravenous acetaminophen was used.  Although the scientists did find a link between intravenous acetaminophen use on postoperative day 0 and 1 and opioid use, length of stay, and cost of hospitalization, the association did not coincide with a consistent pattern of significantly reducing the odds for complications, explains Crispiana Cozowicz, co-author and perioperative research fellow within the Department of Anesthesiology, Critical Care and Pain Medicine at HSS. When compared with the outcomes seen in administering other nonopioid analgesics - pregabalin/gabapentin, specifically – the impact of intravenous acetaminophen was minimal at best.

"We could not show that perioperative intravenous acetaminophen reduces inpatient opioid prescriptions and subsequently reduced odds for adverse outcomes," says Dr. Memtsoudis. "It remains to be determined if and under what circumstances intravenous acetaminophen has a meaningful clinical role in everyday practice."

 

About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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