Determine the Clinical Advantage of IV vs PO Acetaminophen

Phase 4

Completed

Interventions: Drug: Oral Acetaminophen
Drug: Acetaminophen IV Soln
Drug: Saline
Drug: Placebo Pills

Brief Summary: There is limited research on the clinical outcome differences between intravenous (IV) acetaminophen versus oral (PO) acetaminophen. With the costs of intravenous acetaminophen sometimes being almost 100 times the cost of PO acetaminophen, it is not only important fiscally but also clinically to differentiate the benefits of IV vs PO acetaminophen. The proposed research study is to determine the clinical advantages of IV vs PO acetaminophen during the post-operative recovery time for ambulatory surgery patients by analyzing differences in time to first opioid delivery, pain scores, and patient satisfaction.

Detailed Description: In previous literature it has been shown that compared to placebo, IV acetaminophen can improve postoperative pain scores and reduce opioid requirements. In addition, IV acetaminophen has several pharmacokinetic properties that may be beneficial when compared to acetaminophen. IV acetaminophen has been shown to achieve a more rapid and higher maximum plasma concentration as well as higher cerebrospinal fluid concentrations. Comparative effectiveness trials of IV vs PO administration have not conclusively demonstrated improved clinical outcomes despite the proposed pharmacokinetic benefits. More research needs to be conducted to determine possible clinical advantages.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Patients with contraindications to acetaminophen (history of end organ liver dysfunction)
Known allergy to acetaminophen
Emergency surgery
Patients who were not fasted
Patients who cannot tolerate PO
Surgery anticipated to last longer than 3 hours or requiring re-dose of acetaminophen
Pregnancy
Weight less than 50kg
Chronic daily narcotic use
Patients who's anesthetic plan requires regional anesthesia
Patient refusal to participate or do not have capacity to provide consent.

Arm && Interventions

Group	Intervention	Description
Oral Acetaminophen	Oral Acetaminophen	Patients who are randomized to have oral acetaminophen will take oral acetaminophen preoperatively and receive saline intraoperatively.
Oral Acetaminophen	Saline	Patients who are randomized to have oral acetaminophen will take oral acetaminophen preoperatively and receive saline intraoperatively.
Acetaminophen IV Soln	Acetaminophen IV Soln	Patients randomized to IV acetaminophen will receive IV acetaminophen after induction of general anesthesia and will take placebo pills preoperatively.
Acetaminophen IV Soln	Placebo Pills	Patients randomized to IV acetaminophen will receive IV acetaminophen after induction of general anesthesia and will take placebo pills preoperatively.

Primary Outcome Measures

Name	Time	Method
PACU Visual Analogue Pain Scores	baseline, 1 hour, and Day 1 discharge	Post-Anesthesia Care Unity (PACU) pain scores at baseline, 1 hour, and on discharge from PACU. Pain score by visual analogue score, total scale from 0 to 10 with 10 being the worse pain.
Total MME Intraoperatively	Day 1	Total Morphine Milligram Equivalent (MME) use intraoperatively
Total Narcotic Use in PACU.	Day 1	Total narcotic use in PACU expressed in total morphine milligram equivalents (MME)

Secondary Outcome Measures

Name	Time	Method
PACU Length of Stay	up to 24 hours after PACU arrival	Time in PACU
Patient Satisfaction.	7 days post surgery	Patient satisfaction total scale from 1 to 10, with higher score indicating more satisfaction
Patient Reported Total Narcotic Use Post-discharge	average 7 days	home opiod use