Abstract
Background
Oral and intravenous (IV) acetaminophen has become widely used perioperatively as
part of a multi-modal pain management protocol for primary total joint arthroplasty
(TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen
in support of the combined clinical practice guidelines of the American Association
of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee
Society, and American Society of Regional Anesthesia and Pain Management.
Methods
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials
for studies published prior to September 2019 on acetaminophen in primary TJA. All
included studies underwent qualitative and quantitative homogeneity testing followed
by a systematic review and direct comparison meta-analysis to assess the efficacy
and safety of acetaminophen.
Results
In total, 1287 publications were critically appraised yielding 17 publications representing
the best available evidence for analysis. Oral and IV acetaminophen demonstrates the
ability to safely reduce postoperative pain and opioid consumption during the inpatient
hospital stay. No evidence was available to assess the efficacy and safety of oral
acetaminophen after discharge.
Conclusion
Moderate evidence supports the use of oral and IV acetaminophen as a non-opioid adjunct
for pain management during the inpatient hospitalization. Strong evidence supports
the safety of oral and IV acetaminophen when appropriately administered to patients
undergoing primary TJA. Although there is lack of robust evidence for use of acetaminophen
following discharge, it remains a low-cost and low-risk option as part of a multimodal
pain regimen.
Keywords
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Article info
Publication history
Published online: May 28, 2020
Accepted:
May 18,
2020
Received:
April 23,
2020
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.05.037.
Identification
Copyright
© 2020 Published by Elsevier Inc.
