IV OR ORAL ACETAMINOPHEN FOR THA? NEW DATA FROM HSS

Author: Elizabeth Hofheinz, M.P.H., M.Ed. 

To examine the differences in managing pain between oral and intravenous acetaminophen, a team from Hospital for Special Surgery (HSS) in New York conducted a study of 154 total hip arthroplasty patients—some of whom received either IV or oral acetaminophen.

Their work, “IV vs. Oral Acetaminophen as A Component of Multimodal Analgesia After Total Hip Arthroplasty: A Randomized, Blinded Trial,” was published in the March 6, 2019 edition of The Journal of Arthroplasty.

For the study, each patient was randomized to either receive IV acetaminophen or oral acetaminophen. The HSS team then tracked the levels of pain with physical therapy on postoperative day one; opioid side-effects on postoperative day one and, finally, cumulative opioid use.

After looking at their data, the researchers did not find a difference in opioid side effects, pain scores, or opioid use between the two groups.

Co-author Geoffrey Westrich, M.D., an orthopedic surgeon at HSS explained the most important result from the study to OTW, “The most important result was that our multimodal pain management protocol had a very high patient satisfaction rating in both groups.”

“Our results demonstrated that there was no difference in Opioid Related Symptom Distress Scale scores, numerical rating pain scores with physical therapy, or mean oral morphine equivalents between the two groups.”

“Secondary outcomes, including time to discharge, other descriptions of pain outcomes, satisfaction, and cognitive effects were not different between groups.”

“Patient satisfaction was graded on a numerical rating scale from 1 to 10 (with 10 being the most satisfied) and both groups had a rating of 9 out of 10 indicating excellent patient satisfaction with our low opioid multimodal pain management protocol with oral and intravenous acetaminophen.”

Asked about the challenges facing multimodal anesthesia, he said, “It is really the variability in patients’ response to pain management. Some patients need no narcotics, some standard strength narcotics, and some more potent narcotics and we never know until after surgery. We just need to have a solid protocol and be prepared. Having said that, the utilization of a multimodal protocol, in general, requires less narcotics and attacks the pain pathways from different angles.”