Intravenous Acetaminophen Versus Placebo in Post-bariatric Surgery Multimodal Pain Management: a Meta-analysis of Randomized Controlled Trials
Pain management after bariatric surgery is challenging. Recent trials have been exploring the role of intravenous (IV) acetaminophen in multimodal analgesic therapy. This systematic review and meta-analysis assessed the effect of IV acetaminophen compared to placebo for pain management after bariatric surgery.
A comprehensive search of MEDLINE, Embase, CENTRAL, and PubMed databases were performed. Randomized controlled trials (RCTs) comparing IV acetaminophen to placebo as part of multimodal pain management after bariatric surgery in patients with obesity were included. Key outcomes were analyzed using random-effects meta-analysis, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).
Four RCTs including 349 patients met the inclusion criteria, of whom 175 were provided IV acetaminophen and 174 were provided placebo. Patients given IV acetaminophen demonstrated a lower postoperative pain score (mean difference (MD) − 0.66, 95% CI − 1.03 to − 0.28, P < 0.001) 24 h after surgery and lower postoperative opioid use (MD − 6.44, 95% CI − 9.26 to − 3.61, P < 0.001; I2 = 0%) in morphine equivalent doses (MED) within 24 h compared with the placebo group. There was no significant difference in length of stay between groups (MD − 0.26, 95% CI − 0.55 to 0.03, P = 0.08).
The use of IV acetaminophen after bariatric surgery is effective in reducing pain score after 24 h and postoperative opioid doses, but not length of stay. Provided the benefits of IV acetaminophen, its addition to postoperative care and enhanced recovery programs may be warranted.
KeywordsAcetaminophen Postoperative pain management Multimodal analgesia Meta-analysis
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval Statement
For this type of study formal consent is not required.
Informed Consent Statement
Does not apply.
- 2.World Health Organization. Obesity and overweight. 2016. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 24 Oct 2018.
- 4.Chou R, Gordon DB, De Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.CrossRefGoogle Scholar
- 5.Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(Suppl 2):S105–20.Google Scholar
- 6.Lopez PP, Stefan B, Schulman CI, et al. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74(9):834–8.Google Scholar
- 10.Food and Drug Administration. Ofirmev Label | Highlights of Prescribing Information. 2010. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022450lbl.pdf.
- 14.Jibril F, Sharaby S, Mohamed A, et al. Intravenous versus oral acetaminophen for pain: systematic review of current evidence to support clinical decision-making. Can J Hosp Pharm. 2015;68(3):238–47.Google Scholar
- 17.Moher D, Liberati A, Tetzlaff J and Altman D. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151(4):264–269.Google Scholar
- 19.Practical Pain Management. Opioid conversions and opioid dosing calculator - opioid conversion calculator. 1999. Available from: https://opioidcalculator.practicalpainmanagement.com/conversion.php.
- 22.The Cochrane Collaboration. GRADEpro GDT. Cochrane community. 2017.Google Scholar
- 28.Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials † †presented in part at the annual meeting of the Société Française d’Anesthésie-Réanimation, Paris, April 2004. Br J Anaesth. 2005;94(4):505–13.CrossRefGoogle Scholar
- 34.Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21:S1–27.CrossRefGoogle Scholar