Shireesh Saurabh, MD, Jessica K Smith, MD, Paul Jose, Peter Nau, MD, Mark Pederson, Isaac Samuel, MD. University of iowa Hospitals and Clinics.
Introduction: IV acetaminophen potentially reduces postoperative narcotic requirement but has not been tested after LRYGB. Lower narcotic requirements could reduce commonly associated unwanted effects such as nausea, vomiting, itching, dizziness and headache.
Method: A retrospective review of a prospectively maintained database was performed over a 2-year period 2011-2013. 183 patients were identified that received scheduled IV acetaminophen in addition to morphine sulfate (MSO4) patient-controlled analgesia (PCA). A cohort of 229 patients from the preceding two years who were treated with only narcotics was used as a historical control. Patient demographics and narcotic use were recorded. Statistical significance was defined as p < 0.05.
Results: There was no significant difference in age or gender distribution between groups (Table 1). In the postoperative 24 hr period, narcotic analgesic demand (total PCA button pushes including non-delivery of narcotic due to lock-out) was reduced significantly by 25% with the addition of IV acetaminophen (40.5 Vs. 30.9 average pushes; p=0.0017). During the same period, narcotic analgesic requirement was cut down significantly by 20% with the concomitant use of IV acetaminophen (average of 29.9 Vs. 24.1 mg of MSO4; p=0.004). The mean body mass index was similar in the two groups (46 and 48 kg/m2 in control and study group, respectively).
Conclusion: IV acetaminophen reduces the demand for and the requirement of narcotic analgesia after LRYGB. We recommend use of multimodal analgesia with IV acetaminophen and MSO4 PCA in the initial 24 hour period after LRYGB.
| Morphine PCA Only (n 229) | Morphine PCA and IV Acetaminophen (n=189) | P value (t-test) | |
| Age (years) | 43+0.75 ( 18-68) | 44+0.57 (23-68) | 0.73 |
|
Gender – Male, Female |
23% 77% |
16% 84% |
0.08 |
| Narcotic demand (pushes/1st 24 h) | 40.5+3.08 (=2-206) | 30.9+0.78 (0-174) | 0.0017 |
| Narcotic requirement (mg/1st 24 h) | 29.9+1.31 (0-111) | 24.1+ 0.1 (0-117) | 0.004 |
| Total IV acetaminophen in 1st 24 h | 0 mg | 3617 mg |
TABLE 1: Comparison of narcotic demand and requirement using morphine PCA with or without IV acetaminophen after laparoscopic Roux-en-Y gastric bypass. Results are mean + SEM (range).
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