Журнал обезболивания и медицины

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Effect of Multi-Dose Intravenous Acetaminophen on Readiness for Discharge in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Michal Gajewski*, Aziz M Merchant, , Daniel Correa Rodriguez, Dennis Grech, Jean Daniel , Jostnya Rimal , Joel Yarmush, Steven Char, Tamara Berezina, Alex Bekker, Patrick Discepola

Study objective: To determine whether every four-hour dosing of intravenous (IV) acetaminophen can expedite discharge readiness in patients undergoing ambulatory laparoscopic cholecystectomy. Secondary outcomes investigated included the stress hormone response (IL-6, -8, -10, C-reactive protein, epinephrine, norepinephrine, and cortisol), postoperative pain scores, minutes to first rescue medication, need for additional antiemetics, the overall dose of postoperative opioids administered, Postoperative Nausea and Vomiting (PONV) incidence, and patient satisfaction.

Design: 65 patients were included in the final analysis of this double-blinded, randomized, placebo- controlled, two-arm parallel trial. Blood samples were drawn immediately following IV catheter insertion, prior to incision, and one hour after arrival in recovery while readiness for discharge was evaluated using the SPEEDs criteria (saturation, pain, extremity movement, emesis, dialogue, stable vital signs).

Results: Discharge readiness within 2 hours was observed in 97.1% of patients in the study group and 83.9% in the placebo group (p=0.096). Median VAS pain scores at 15 min and the worst VAS scores were higher in the placebo group (nine vs. seven, p=0.013). Patients that received the placebo were 96% less likely to be ready for discharge in 2 hours when stratifying across race and controlling for ASA status, IL-6, cortisol, and norepinephrine levels (p=0.0424).

Conclusion: Although the use of every four hour intravenous acetaminophen dosing increased the number of patients ready for discharge at 2 hours, the study failed to show a statistical significance due to the low sample size. Larger studies can potentially show an economic impact.