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IV acetaminophen could represent a useful adjunct to multimodal analgesia as it significantly decreased the amount of oral narcotics required for pain relief after post-cesarean delivery.
Cesarean Delivery is one of the most regular surgeries, with cases continuing to accelerate. Doctors must consider the increasing concern with opioid misuse, addiction, and side effects with favorable postoperative pain control. Acetaminophen administered by the intravenous route may serve as a promising option to reduce the dependence on opioids and improve postoperative pain after C-section.
Lately, a double-blind, randomized controlled trial was conducted to estimate if the intravenous administration of acetaminophen after C-section would decrease the need for opioids in managing postoperative pain. The women were scheduled to go through cesarean delivery with local anesthesia as per norms. Further, all perioperative and postpartum care was also standardized by trial order sets.
A total of 133 women were selected for the study. Out of which, 29 were excluded. From remaining participants, 47 obtained placebo and remaining 57 obtained acetaminophen.
The women of both groups received a total of six doses of either 1000 mg acetaminophen or 100 ml saline at every 8 hours for 48 hours. Women received the initial dose of study drug within 60 minutes of skin incision. The pharmacy prepared the doses of acetaminophen and saline in identical administration bags labeled study drug to assure blinding. The faces pain scale (0-10) was used to evaluate pain levels and quality of analgesic medication & breakthrough, before and after drug administration. The patient demographics were also derived from the chart. Further, according to power calculations, about 45 patients per group were needed to observe a 30% decline in post-cesarean narcotic requirement with 80% power.
The results of the study showed no change in baseline demographic characteristics such as race, comorbidities, patient age, body mass index, number of prior cesarean deliveries, gravidity or parity. Also, no change was seen in estimated blood loss or length of stay among the groups as well. The pain scale also showed no difference before and after study dose administration. The amount of oral narcotics medicines was significantly reduced in patients who received acetaminophen intravenously as compared to the patients in the placebo group. No significant change was observed in narcotic side effects in either group.
Thence, the study shows that intravenous acetaminophen shows significant positive results in post-cesarean delivery pain control. The oral narcotic consumption for pain control is also reduced with intravenous acetaminophen use.
American Journal of Obstetrics and Gynecology
Randomized Controlled Trial of Intravenous Acetaminophen for Post-Cesarean Delivery Pain Control
Brie Altenau et al.
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