P003: IV ACETAMINOPHEN: EFFICACY IN REDUCING NARCOTIC CONSUMPTION IN LAPAROSCOPIC CHOLECYSTECTOMY
Marissa Erekson, SRNA1, Patrick Ziemann-Gimmel, MD2, Allison A Goldfarb, ARNP, DNP, CRNA2; 1UNF, 2Sheridan
Introduction/Background: One of the central components of an anesthesia provider’s role is to provide adequate analgesia in the perioperative period. Opioids are a commonly used intervention; however opioids are documented in literature to contain side effects of nausea, vomiting, respiratory depression, and constipation. The use of intravenous (IV) acetaminophen as part of multimodal analgesia has been shown to decrease the amount of narcotics required in the perioperative period. There is limited evidence if this benefit is applicable for laparoscopic cholecystectomies. The purpose of this study was to determine if the perioperative use of IV acetaminophen would improve patient outcomes and pain control while decreasing the use of opioids and the incidence of nausea and vomiting in this patient population.
Methods: This study is a retrospective chart review of a single-center to assess the efficacy of using IV acetaminophen to improve analgesia in laparoscopic cholecystectomy surgeries. All patients who underwent laparoscopic cholecystectomy surgeries from April through September 2015 were reviewed. Data collected included pain and antiemetic medications administered in the perioperative period, timing of medications, pain scores, and liver function test (LFT) lab work. Opioids were converted to morphine equivalent doses for comparison.
Results: Records were reviewed from 203 patients; eighteen were not included in the statistical analysis as these patients had additional procedures performed at the same time. The patient population included inpatient and outpatient, male and female, American Society of Anesthesiologists (ASA) physical status classification classes I-IV, and emergent and non-emergent patients. Of the 185 patients, 121 received IV acetaminophen and 64 did not receive IV acetaminophen during the perioperative period. The results indicated that there was no statistical difference in the immediate perioperative period in the pain scores or amount of narcotics administered between patients who did and did not receive IV acetaminophen.
Discussion: Though there was not a statistical difference in amount of narcotics administered, a few factors may have played a role in the decision and ability to select IV acetaminophen. The non-IV acetaminophen group had a higher percentage of emergency cases (p=0.035) and elevated total bilirubin values (p=0.056) that may have affected the selection of pain control medications.
Conclusion: The results of this study do not indicate additional benefits in analgesia or a decrease in narcotic consumption when utilized for the laparoscopic cholecystectomy patient. A study of a larger population may present different findings. It may be that the pain stimulus from this procedure when performed by the experienced surgeons at this facility does not generate a level of pain that requires the introduction of IV acetaminophen, despite its proven efficacy in other types of operations.