Continuous Multimechanistic Postoperative Analgesia: A Rationale for Transitioning from Intravenous Acetaminophen and Opioids to Oral Formulations

Joseph V. Pergolizzi, Robert B. Raffa, Ronald Tallarida, Robert Taylor, Sumedha A. Labhsetwar

Research output: Contribution to journalArticlepeer-review

Abstract

Good surgical outcomes depend in part on good pain relief, allowing for early mobilization, optimal recovery, and patient satisfaction. Postsurgical pain has multiple mechanisms, and multimechanistic approaches to postoperative analgesia are recommended and may be associated with improved pain relief, lowered opioid doses, and sometimes a lower rate of opioid-associated side effects. Acetaminophen (paracetamol) is a familiar agent for treating many types of pain, including postsurgical pain. Oral acetaminophen has been shown to be safe and effective in a variety of acute pain models. Combination products using a fixed-dose of acetaminophen and an opioid have also been effective in treating postsurgical pain. Combination products with acetaminophen have demonstrated an opioid-sparing effect, which inconsistently results in a reduced rate of opioid-associated side effects. Intravenous (IV) acetaminophen and an opioid analgesic administered in the perioperative period may be followed by an oral acetaminophen and opioid combination in the postoperative period. Transitioning from an IV acetaminophen and opioid formulation to a similar but oral formulation of the same drugs appears to be a reasonable step in that both analgesic therapies are known to be safe and effective. For postsurgical analgesia with any acetaminophen product, patient education is necessary to be sure that the patient does not concurrently take any over-the-counter products containing acetaminophen and accidentally exceed dose limits.

Original languageEnglish (US)
Pages (from-to)159-173
Number of pages15
JournalPain Practice
Volume12
Issue number2
DOIs
StatePublished - Feb 2012

Keywords

  • Acetaminophen
  • Intravenous acetaminophen
  • Intravenous paracetamol
  • Paracetamol
  • Postsurgical pain management

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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