Category: Professional Posters
Purpose: Multimodal pain management has led to interest in using non-opioid analgesics, including intravenous acetaminophen (IV APAP, Ofirmev®). One potential benefit for its use is its opioid sparing properties. Clinical trials found 46% less morphine consumption over 24 hours in total hip and knee replacement patients that received IV APAP vs. those that did not. This study aims to identify the effects of opioid use following the implementation of a 24 hour IV APAP restriction.
Methods: This is a retrospective, single center study evaluating opioid utilization pre- (Jan to Aug 2017) and post- implementation (Sep 2017 to Dec 2018) of an IV APAP restriction. Pre-implementation, there was no restriction on the use of IV APAP and durations greater than 24 hrs were allowed. A restriction was implemented in September 2017 which limited use of IV APAP to 24 hours post-operatively. To measure the effect of the restriction, opioid consumption was compared between groups. Opioid consumption was collected for the entire length of stay for patients who received IV APAP within the study timeframe. Consumption was measured by morphine milligram equivalents (MME) received for opioids on the post-operative order sets. These opioids included injectable hydromorphone and morphine as well as oral oxycodone, hydrocodone/acetaminophen and oxycodone/acetaminophen.
Results: 233 patients were identified in the pre-implementation group and 701 in the post-implementation group. The average opioid consumption (MME) was similar between groups (238 pre-implementation vs. 193 post-implementation). The mean+SD MME per opioid before and after implementation were as follows: oxycodone (83.3±115 vs 56.6±118), oxycodone/acetaminophen (17.3±71.9 vs 32.9±93.3), hydrocodone/acetaminophen (41.3±142 vs 38.5±91.2), injectable morphine (27.4±75.7 vs 28.2±90.6) and injectable hydromorphone injectable (68.5±419 vs 38.2±134).
Conclusion: At this facility, IV APAP was often used for greater than 24 hrs in an attempt to reduce opioid consumption. As a result, it was feared that restriction to 24 hrs may increase opioid consumption. However, implementation of a 24-hour IV APAP restriction program did not increase total opioid consumption in post-operative patients receiving IV APAP.