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Intravenous acetaminophen
significantly reduces the use of narcotics on the day of surgery. It also
reduces the length of hospital stay post transapical transcatheter aortic valve
replacement.
The introduction of intravenous acetaminophen reduced the
narcotic use during surgery and overall length of stay among the patients who
went through transapical transcatheter aortic valve replacement (TA-TAVR). Pain
management is very crucial after TA-TAVR. As the opioid-based postoperative
pain management raised certain complications, new approaches involved
non-opioid agents in managing pain. This study aimed to determine the
intravenous acetaminophen's opioid-sparing effect among the 43 patients who
were going through TA-TAVR from November 2012 to March 2014.
23 patients, before acetaminophen formulary availability
received the standard postoperative pain management involving oral narcotics/acetaminophen
and intravenous narcotics. Once the acetaminophen was available, 20 patients
had received ≥4 doses of 4 g/d intravenous acetaminophen and supplemental
intravenous non-acetaminophen oral narcotics. Both the groups were compared for
hospital length of stay (LOS), daily narcotic dose and drug costs.
Patients of both groups showed similar baseline
characteristics involving the Society of Thoracic Surgery mortality risk (P =
0.3). The median cost per patient was of US $221 with the 6.5 median intravenous
acetaminophen doses. Fewer morphine equivalents on postoperative day 0 (22.5 vs
45.0) and shorter median length of stay (5.0 vs 7.0 days) were significantly
more among patients who took intravenous acetaminophen as compared to the
non-acetaminophen group (p = 0.03, 0.007, respectively). After adjusting for
the Society of Thoracic Surgery risk the group with intravenous acetaminophen
remained associated with fewer median postoperative LOS (P = 0.049). The
outcomes reflected the significant opioid-sparing effect of intravenous
acetaminophen during TA-TAVR.
Innovations
Intravenous Acetaminophen Improves Outcomes After Transapical Transcatheter Aortic Valve Replacement.
Keith B. Allen et al.
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