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.