Analgesic Safety of Periodic Intravenous Infusion of Acetaminophen After Hepatectomy: A Propensity Score Matching Analysis

Background and Aim: Acetaminophen is an often-used analgesic for management of postoperative pain; it is not associated with hypomotility of the gastrointestinal tract or postoperative nausea and vomiting. It may, however, negatively affect liver function. Thus, acetaminophen is rarely used after hepatectomy and there are few studies pertaining to the analgesic safety of such use. We investigated the analgesic safety of periodic intravenous infusion of acetaminophen following hepatectomy. Patients and Methods: The study included 92 patients who had undergone hepatectomy without biliary reconstruction at St. Marianna University Hospital between January 2014 and November 2018. These patients were identified from among a larger group of patients, and propensity score matching allowed for the creation of two study groups: 46 patients who had undergone periodic intravenous infusion of acetaminophen for postoperative pain management (Group A), and 46 control patients who had undergone bolus injections of the non-steroidal antiinflammatory drug upon request (Group C). The two groups were then compared retrospectively in terms of clinical characteristics; operative variables; details regarding postoperative analgesia; concentrations of serum liver enzymes (total bilirubin [TBL], aminotransaminases aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP] and gamma-glutamyl transpeptidase [γGTP]) determined preoperatively, on postoperative days (PODs) 1, 3 and 7, and between PODs 14 and 28; and in-hospital outcomes and complications. Results: Patients’ clinical characteristics and operative variables did not differ between the two groups. Of the liver enzymes, only the serum γGTP concentrations observed on POD 7 and POD 14 differed significantly (p=0.003 and p=0.017, respectively). No patient suffered CTCAE Grade ≥ 3 hepatic failure, and there was no mortality. Conclusion: Results of our study indicate that periodic intravenous infusion of acetaminophen after hepatectomy is a safe means of managing patients’ postoperative pain.

[1]  Versione,et al.  Common Terminology Criteria for Adverse Events , 2020, Definitions.

[2]  G. Noori,et al.  A comparative study on the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain in patients with laparoscopic cholecystectomy , 2018, Medicine.

[3]  J. Shindoh,et al.  A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis , 2018, Surgery Today.

[4]  J. Golembiewski Intravenous Acetaminophen , 2017, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[5]  R. N. Brogden,et al.  Nefopam: A Review of its Pharmacological Properties and Therapeutic Efficacy , 1980, Drugs.

[6]  S. Groudine,et al.  Use of intravenous acetaminophen in the treatment of postoperative pain. , 2011, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[7]  M. Royal,et al.  A randomized, double-blind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. , 2010, Clinical therapeutics.

[8]  A. Dixon,et al.  The evolution of analgesia in an ‘accelerated’ recovery programme for resectional laparoscopic colorectal surgery with anastomosis , 2010, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[9]  Douglas W. Wilmore,et al.  Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery , 2008, Annals of surgery.

[10]  J. Jakobsson,et al.  Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. , 2005, Journal of cardiothoracic and vascular anesthesia.

[11]  K. Lassen,et al.  Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. , 2005, Clinical nutrition.

[12]  N. Demartines,et al.  Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey , 2004, Annals of Surgery.

[13]  O. Mimoz,et al.  Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection* , 2001, Anaesthesia.

[14]  A. Burlingame,et al.  Identification of the Hepatic Protein Targets of Reactive Metabolites of Acetaminophen in Vivo in Mice Using Two-dimensional Gel Electrophoresis and Mass Spectrometry* , 1998, The Journal of Biological Chemistry.

[15]  J. Keski‐Oja,et al.  A Review of its Pharmacological Properties and Therapeutic Efficacy in the Management of Psoriasis , 1996 .

[16]  E. Iannace,et al.  Effect of ketorolac, ketoprofen and nefopam on platelet function , 1994, Anaesthesia.

[17]  G. Kenny,et al.  Postoperative nefopam and diclofenac Evaluation of their morphine‐sparing effect after upper abdominal surgery , 1990, Anaesthesia.