Evaluating the Effect of Intravenous Acetaminophen in Multimodal Analgesia After Total Hip Arthroplasty: A Randomized Controlled Trial |
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| Affiliation: | 1. Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan;2. Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan;1. Board Member-At-Large, American Association of Hip and Knee Surgeons University of Virginia, USA;2. Member, Hip Society, Rush University Medical Center, USA;3. Member, Knee Society, Stanford University, USA;4. President, American Association of Hip and Knee Surgeons Rush University Medical Center, USA;1. Rothman Orthopaedic Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA;2. Rothman Orthopaedic Institute, Bryn Mawr Hospital, Bryn Mawr, PA;3. Bryn Mawr Hospital, Bryn Mawr, PA |
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| Abstract: | BackgroundPostoperative pain is a significant concern of patients before surgery. Multimodal pain management is an effective method of pain control after major orthopedic surgery. Acetaminophen is the most commonly used analgesic for the management of pain. It was hypothesized that 1000 mg of intravenous acetaminophen (IA) dosed every 6 hours would significantly reduce the postoperative pain score at rest and the opioid consumption volume in patients who would undergo total hip arthroplasty (THA) when compared to a control group.MethodsA single-center, prospective, open-label randomized control study was conducted. A total of 97 patients undergoing unilateral primary THA were divided into 2 groups: the study group (IA) (n = 45) and the control group (n = 52). The study group received administered IA after surgery, while the control group received only a standard pain control. Both groups received a preoperative femoral nerve block and postoperative intravenous fentanyl citrate. The primary outcome was the evaluation of the pain score at rest 24 hours after surgery. The pain score was measured using the Numerical Rating Scale. The primary outcome of this study was analyzed using generalized estimating equation.ResultsThe IA group had a significant improvement in Numerical Rating Scale score at rest 24 hours after THA compared to the control group (−0.91, 95% confidence interval −1.56 to −0.26, P = .006), suggesting a positive effect of IA usage for pain relief. The total fentanyl citrate consumption after surgery for 24 hours was significantly lower in the IA group than those of the control group (52.07 ± 7.64 vs 57.83 ± 12.44 mg, P < .001).ConclusionPostoperative administration of IA significantly reduced the postoperative pain score and opioid consumption volume after primary THA. IA was useful as one role of multimodal pain management after THA.Level of Evidence: Level 2. |
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| Keywords: | acetaminophen pain control multimodal analgesia total hip arthroplasty randomized controlled trial opioid consumption |
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