IV / Parental Acetominophen for Postoperative Analgesia

• IV / parenteral administration of acetaminophen:
  • Achieves the fastest and highest elevation of plasma drug concentration:
    • Higher plasma levels:
      • Are associated with reports of:
        • Improved postoperative pain scores
        • Decreased opioid use
• Although IV acetaminophen is more expensive than oral and rectal formulations:
  • These improved metrics are evidence that support the use of IV acetaminophen despite the price difference
• IV / parenteral administration has the effects of:
  • Decreased hospital time to discharge
  • Decreased opioid-associated side effects including:
    • Ileus
    • Urinary retention
    • Nausea / vomiting
• In addition to improved patient satisfaction scores:
  • These effects result in an overall cost savings to the healthcare system:
    • Justifying the use of IV acetaminophen as part of a multimodal analgesic approach in a carefully selected group of patients, including those at:
      • High risk of post-operative nausea and vomiting (PONV) and difficult-to-control pain
• References:
  • Singla NK, Parulan C, Samson R, Hutchinson J, Bushnell R, Beja EG, Ang R, Royal MA. Plasma and cerebrospinal fluid pharmacokinetic parameters after single-dose administration of intravenous, oral, or rectal acetaminophen. Pain Pract. 2012 Sep;12(7):523-32.
  • Shaffer EE, Pham A, Woldman RL, Spiegelman A, STrassels SA, Wan GJ, et al. Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs. Adv Ther. 2017;33(12):2211–2228.

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