Surgery Today

, Volume 48, Issue 5, pp 502–509 | Cite as

A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis

  • Yu Ohkura
  • Junichi Shindoh
  • Masaki Ueno
  • Toshiro Iizuka
  • Shusuke Haruta
  • Harushi Udagawa
Original Article



To investigate the efficacy of postoperative scheduled intravenous acetaminophen to reduce the opioid use and enhance the recovery after esophagectomy.


A propensity score-matched population was created using the 93 and 69 consecutive patients who underwent esophagectomy for esophageal cancer before and after the introduction of postoperative scheduled intravenous acetaminophen, and the short-term clinical outcomes were compared.


Significant defervescence was demonstrated in the Acetaminophen group (A-group) compared with control group (C-group) during the perioperative period (p < 0.05), whereas no significant differences were observed in the postoperative inflammatory parameters. The incidence of postoperative complications was similar between the groups. The number of PCA pushes and the frequency of using other non-opioid analgesics were significantly smaller in the A-group than in the C-group (p < 0.05). Both daily and cumulative opioid uses were significantly smaller in the A-group than in the C-group (p < 0.05). The time to first flatus was significantly shorter in the A-group than in the C-group (p < 0.001). The day of first walking after surgery was significantly earlier in the A-group than in the C-group (1.0 versus 2.0 days, p = 0.003). The ICU stay (2.86 versus 3.61 days, p < 0.001) and the hospital stay (21.5 versus 26.0 days, p = 0.061) tended to be shorter in the A-group than in the C-group.


Postoperative scheduled intravenous acetaminophen decreased the rate of opioid use without increasing the intensity of postoperative pain and may be a feasible new pain management option in the enhanced recovery after surgery protocol following esophagectomy.


Esophageal cancer Acetaminophen Pain management Propensity score matching ERAS 



We thank Dr. Erika Ohkura for her English proofreading of our manuscript.

Author contributions

Study conception: YO, JS, and MU. Data accumulation: all authors. Data analysis: YO, JS, and MU. Writing of the manuscript: all authors. Critical revision: YO, JS, MU, and HU.

Compliance with ethical standards

Informed consent

Written informed consent was obtained from all of the patients for the publication of this report.

Conflict of interest

All authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhauq A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–77.CrossRefPubMedGoogle Scholar
  2. 2.
    Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.CrossRefPubMedGoogle Scholar
  3. 3.
    Jensen K, Kehlet H, Lund CM. Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime. Acta Anaesthesiol Scand. 2007;51(4):464–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Ohkura Y, Haruta S, Shindoh J, Tanaka T, Ueno M, Udagawa H. Effectiveness of postoperative intravenous acetaminophen (Acelio) after gastrectomy: a propensity score-matched analysis. Medicine (Baltimore). 2016;95(44):e5352.CrossRefGoogle Scholar
  5. 5.
    Sobin LH, Gospodarowicz MK, Wittekind C, editors. International Union Against Cancer. Oesophagus including oesophagogastric junction. “TNM classification of malignant tumours”. West Sussex: Wiley-Blackwell; 2009. pp. 66–72.Google Scholar
  6. 6.
    Candiotti K, Singla N, Wininger S. A randomized, double-blind, placebo-controlled, multi-center, parallel-group, multiple-dose study of the efficacy and safety of intravenous acetaminophen over 48 h for the treatment of postoperative pain after gynecologic surgery. In: American Society of Regional Anesthesia & Pain Medicine, 33rd Annual Spring Pain Meeting & Work shops; 2008.Google Scholar
  7. 7.
    National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Publish: May 28, 2009 (v4.03: June 14, 2010).
  8. 8.
    Akiyama H, Miyazono H, Tsurumaru M, Hashimoto C, Kawamura T. Use of the stomach as an esophageal substitute. Ann Surg. 1978;188:606–10.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Udagawa H, Ueno M, Kinoshita Y. Rationale for video-assisted radical esophagectomy. Gen Thorac Cardiovasc Surg. 2009;57:127–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Udagawa H, Ueno M, Shinohara H, Haruta S, Nakagawa M, Tsurumaru M. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol. 2012;106(6):742–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Ohkura Y, Ueno M, Iizuka T, Haruta S, Tanaka T, Udagawa H. Factors predicting effectiveness of neoadjuvant therapy for esophageal squamous cell carcinoma. Medicine (Baltimore). 2016;95(15):e3365.CrossRefGoogle Scholar
  12. 12.
    Bjorkman DJ, Kimmey MB. Non steroidal anti-inflammatory drugs and gastrointestinal disease: pathophysiology, treatment and prevention. Dig Dis. 1995;13(2):119–29.CrossRefPubMedGoogle Scholar
  13. 13.
    Scott G, Susan F. Use of intravenous acetaminophen in the treatment of postoperative pain. J Peri Anesthesia Nurs. 2011;26(2):74–80.Google Scholar
  14. 14.
    Zafar N, Davies R, Greenslade GL, Dixon AR. The evolution of analgesia in an ‘accelerated’ recovery programme for resectional laparoscopic colorectal surgery with anastomosis. Colorectal Dis. 2010;12:119–24.CrossRefPubMedGoogle Scholar
  15. 15.
    Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systemic review and evidence-based guidelines. Ann surg. 2014;259(3):413–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Honda M, Daiko H, Kinoshita T, Fujita T, Shibasaki H, Nishida T. Minimally invasive resection of synchronous thoracic esophageal and gastric carcinomas followed by reconstruction: a case report. Surg Case Rep. 2015;1(1):12.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2017

Authors and Affiliations

  • Yu Ohkura
    • 1
    • 2
  • Junichi Shindoh
    • 1
    • 2
  • Masaki Ueno
    • 1
    • 2
  • Toshiro Iizuka
    • 2
    • 3
  • Shusuke Haruta
    • 1
  • Harushi Udagawa
    • 1
    • 2
  1. 1.Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
  2. 2.Okinaka Memorial Institute for Medical ResearchTokyoJapan
  3. 3.Department of GastroenterologyToranomon HospitalTokyoJapan

Personalised recommendations