The role of intravenous acetaminophen in post-operative pain control in head and neck cancer patients

Objective This study investigated the role of intravenous acetaminophen for alleviation of postoperative pain after surgical resection of head and neck cancers. Methods A single-center study was conducted, which investigated a prospective group of 48 participants who underwent surgery between April 2016 and May 2017 and postoperatively received scheduled IV acetaminophen (1 g every 6 hours for 4 doses) plus the standard opioid PCA and breakthrough narcotics. These were compared to a similar retrospective cohort of 51 patients who had surgery between January 2014 to March 2015 and only received an opioid patient controlled analgesia (PCA) pump and breakthrough narcotics. Outcome measures included averaged pain scores, total amount of narcotics received (in morphine equivalents), and number of PCA attempts measured in 8-hour intervals over the first 24 hours, as well as duration of PCA and length of stay. Statistical measures included descriptive analysis and gamma regression analysis. Results The acetaminophen group achieved equally low pain scores (0.8 +/- 1.2 vs. 1.0 +/- 1.3, P = .408) with significantly less total narcotics in the first 8 hours after surgery (13.5 +/- 13.3 vs. 22.5 +/- 21.5 MEs, P = .014). This group had a significantly decreased length of stay (7.8 +/- 4.6 vs. 10.6 +/- 7.6 days, P = .03). Conclusion This study demonstrates that intravenous acetaminophen may play a role in reducing the total narcotic requirement in the first 8 hours after surgery and contribute to a decreased length of stay and potentially decrease cost to the patient and hospital overall. Future research should be aimed at comparing these groups in a randomized control study/setting. Level of Evidence 3