Acetaminophen

There is one high quality (Murata-Ooiwa 2017) and 2 moderate quality studies (Sinatra 2012, Takeda 2019) that demonstrate improved pain at rest in patients receiving acetaminophen. There are 3 high quality studies and 2 moderate quality studies demonstrating reduced opioid consumption in patients receiving 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.

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

Acetaminophen is a widely available, inexpensive, generic, over the counter analgesic that does not require significant resources compared to opioids.

Acceptability

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

Feasibility

Acetaminophen is a widely used analgesic in the United States.

Future Research

Superiority to placebo is well established. 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.