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Complications with opioid-based postoperative pain management have led to guideline recommendations for a multimodal analgesia strategy incorporating nonopioid agents.
The transapical
approach (TA) is an established access substitute for the transfemoral method
in patients undergoing transcatheter aortic valve replacement (TAVR) for the
symptomatic aortic valve stenosis treatment. This retrospective study pointed
out that the patients who received intravenous acetaminophen used significantly
fewer morphine equivalents on and had a shorter median length of stay.
Complications
with opioid-based postoperative pain management have led to guideline
recommendations for a multimodal analgesia strategy incorporating nonopioid
agents. The opioid-sparing effect of intravenous acetaminophen in patients
undergoing transapical transcatheter aortic valve replacement was
evaluated.
A
multimodal pain management method that comprised intravenous acetaminophen was
retrospectively evaluated in 43 patients undergoing transapical transcatheter
aortic valve replacement between November 2012 and March 2014. Before
intravenous acetaminophen formulary availability, 23 patients received standard
postoperative pain management interventions including intravenous narcotics and
oral narcotics/acetaminophen. After intravenous acetaminophen availability, 20
patients received intravenous acetaminophen (4 g/d, ≥4 doses) and supplemental
intravenous and non-acetaminophen oral narcotics. Daily narcotic dose
(standardised to morphine equivalents), drug cost, and hospital length of stay
were compared among groups.
Baseline
characteristics were similar between intravenous acetaminophen (n = 20) and
nonintravenous acetaminophen (n = 23) patients including the Society of
Thoracic Surgery mortality risk (10.5% vs 9.0%). The median number of
intravenous acetaminophen doses was 6.5 (interquartile range = 4.0-18.5), with
a median cost per patient of US $221 (interquartile range = $136-$629).
Patients who received intravenous acetaminophen used significantly fewer morphine
equivalents on postoperative day 0 compared with patients not receiving
intravenous acetaminophen (22.5 vs 45.0 morphine equivalents, P = 0.03) and had
a shorter average length of stay (5.0 vs 7.0 days). After adjusting for the
Society of Thoracic Surgery risk, intravenous acetaminophen continued to be
associated with a reduction in median postoperative length of stay [-1.9 days
(95% confidence interval = -0.9 to -8.2 days)].
A multimodal pain management
strategy incorporating intravenous acetaminophen in patients undergoing
transapical transcatheter aortic valve replacement was associated with
reductions in narcotic use on the day of surgery and overall length of stay.
Innovations
Intravenous Acetaminophen Improves Outcomes After Transapical Transcatheter Aortic Valve Replacement.
Molund M et al.
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