Effectiveness of intravenous acetaminophen for pain management in orthopedic surgery patients: a systematic review.

Background: Fear of poor pain management has been listed by patients as a reason for delaying or refusing surgical procedures. Uncontrolled pain has been associated with increased time in the post anesthesia care unit, poor sleep, increased hospital length of stay and decreased patient satisfaction. Acetaminophen (paracetamol) has been used for more than a century to control pain and to treat fever in both adults and children. The intravenous formulation has been available in Europe for many years, but it has only recently become available in the United States.

Review Objective: The objective was to synthesize the best available evidence regarding the safety and efficacy of intravenous acetaminophen (paracetamol) for pain control after an orthopedic surgical procedure.

Inclusion Criteria: The review considered patients 18 years of age and older who had received intravenous acetaminophen (paracetamol) for pain control after an orthopedic surgical procedure.This review considered as intervention the intravenous acetaminophen (paracetamol) for pain control after an orthopedic surgical procedure.This review considered the following outcome measures: pain intensity, pain relief, pain scores, use of rescue medication, adverse event reporting, and patient satisfaction scores.This review considered only randomized controlled trials.

Search Strategy: The search strategy aimed to find both published and unpublished studies in English language from 2006 to 2011. Multiple databases were searched including MEDLINE, CINAHL, EMBASE, and EBSCO.

Methodological Quality: The studies were critically appraised using the standardized instruments provided by the Joanna Briggs Institute.

Data Collection: Data was extracted using standardised data extraction form provided by the Joanna Briggs Institute DATA SYNTHESIS: Due to the heterogeneous nature of the study methods meta-analysis was considered not appropriate. The results are presented in a narrative summary.

Results: The use of intravenous acetaminophen (paracetamol) for the treatment of pain and fever is gaining increased acceptance across a wide variety of patients despite limited research. The systematic review to identify randomized control trials in orthopedic patients identified only two such studies. These studies were in vastly different patient groups and the results of which could not be combined for meta-analysis.

Conclusions: The results of this review indicate that intravenous acetaminophen (paracetamol) has been used during and following a variety of orthopedic surgical procedures with moderate improvement in post procedural pain, but did not substantially change the need for rescue medications.

Implications For Practice: The studies included in this review provide insufficient evidence to support the routine use of intravenous acetaminophen (paracetamol) for pain control following orthopedic surgical procedures.

Implications For Research: Further research is needed in a broader patient population. Measurements for interventions and outcomes need to be standardized in order to ensure proper comparison and application of results.