Oral Acetaminophen

There are 2 high quality (Westrich 2019, Hickman 2018) 1 moderate quality studies (Politi 2017) and one low quality (Suarez 2018) showing no difference in pain scores or opioid use in patients receiving intravenous versus oral acetaminophen. There are 2 high quality studies showing no difference in adverse events between IV and oral acetaminophen.

Benefits/Harms of Implementation

Reducing opioid use in the post-op period reduces opioid-related side-effects such as nausea/vomiting, respiratory depression, opioid tolerance/abuse, etc. Acetaminophen is a well-accepted as a safe analgesic with minimal to no side effects in the vast majority of patients. The safety of oral and intravenous formulations is well established and widely accepted.

Outcome Importance

The US is in the midst of an opioid epidemic known to contribute to the development of hyperalgesia, tolerance, dependence, addiction, and abuse. Therefore, reducing opioid use is a national priority.

Cost Effectiveness/Resource Utilization

Oral acetaminophen is a widely available, inexpensive, generic, over the counter analgesic that does not require significant resources compared to opioids. Intravenous acetaminophen is much more costly than the oral route of administration with no difference in pain relief or side effects. If patients are able to take oral medications using acetaminophen po will result in decreased costs and similar analgesia.

Acceptability

Acetaminophen is widely accepted as an analgesic by orthopedic surgeons, anesthesiologists as well as patients. The tolerance of oral acetaminophen is extremely high with very few contraindications.

Feasibility

Acetaminophen is a widely used analgesic in the United States. Intravenous acetaminophen requires the presences of intravenous access but should be considered an excellent option for patients unable to take oral medications.

Future Research

It is well established that acetaminophen po vs. the intravenous route is similar in efficacy with regard to onset and pain relief. Future research should consist of analgesic combinations and the degree of opioid sparring. Future pain outcomes should be investigated in patients with chronic pain, pre-operative opioid use.