A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/295392
A6 Bariatric Times [MAY 2014, SUPPLEMENT A] HOT TOPICS IN SURGICAL PAIN MANAGEMENT There were no significant differences between IV acetaminophen and placebo groups regarding the i ncidence of AEs. Constipation, nausea, anemia, pruritus, and vomiting were the most frequently reported AEs in both groups. 18 IV acetaminophen also has demonstrated rapid analgesic efficacy versus placebo in an emergency d epartment (ED) setting. In patients presenting to the ED with renal colic, Bektas and colleagues found rapid reductions in pain intensity at 15 and 30 minutes after receiving 1g of IV or 0.1mg/kg of morphine versus placebo (Figure 5). IV fentanyl was available to patients with inadequate pain relief at 30 minutes. Statistically significant mean differences in pain intensity reductions compared with those for placebo were observed for IV acetaminophen (16; 95% CI, 5–27; P=0.005) and morphine (14; 95% CI, 0.4–27; P=0.05); however, no difference was found between IV acetaminophen and morphine (2; 95% CI, –13–16; P=0.74). 26 This study was not designed as a head-to-head, noninferiority trial. Preemptive Analgesic Efficacy of OFIRMEV As part of a multimodal analgesic approach, the ASA Guidelines recommend that preoperative initiation of analgesia for postoperative pain should be considered during patient preparation for perioperative pain management. 12 The following study evaluated the effect of IV acetaminophen on postoperative pain when used preemptively (preoperatively or intraoperatively). In a study of 90 patients undergoing total abdominal hysterectomy, Arici and colleagues evaluated the effect of IV acetaminophen 1g given preoperatively (30 minutes prior to induction), IV acetaminophen 1g given intraoperatively (at skin closure), or placebo. All patients had PCA morphine freely available as rescue. Results showed that postoperative pain intensity scores were significantly lower for both IV acetaminophen groups, preoperatively and intraoperatively, compared with placebo (P<0.05) (Figure 6). 27 Reduced Opioid Consumption With OFIRMEV Reduced opioid consumption with IV acetaminophen has been demonstrated in a number of RCTs across a variety of surgical procedures with significant reductions compared with placebo. In total hip and knee replacement, 1g IV acetaminophen plus PCA morphine significantly reduced morphine consumption compared with placebo with PCA morphine (–46% over 6 hours, P<0.01; –33% over 24 hours, P<0.01) (Figure 7a). Median time to first rescue medication use was significantly longer with IV acetaminophen compared with placebo (3 hours versus 0.8 hours, P=0.0001). 18 Arici and colleagues found that IV acetaminophen plus standard of care demonstrated significantly less FIGURE 6. Mean pain intensity scores following total hysterectomy surgery Arici S, et al. Agri. 2009;21:54-61. FIGURE 5. Rapid reductions in pain intensity in renal colic This study was not designed as a head-to-head, noninferiority trial. Bektas F, et al. Ann Emerg Med. 2009;54:568-574. FIGURE 4. Study in major orthopaedic surgery Sinatra RS, et al. Anesthesiology. 2005;102:822-831. EDITED-Cadence Ofirmez Suppl copy 2_Layout 1 4/14/14 10:14 AM Page A6