Abstract
Purposes
To investigate the efficacy of postoperative scheduled intravenous acetaminophen to reduce the opioid use and enhance the recovery after esophagectomy.
Methods
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.
Results
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.
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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.
Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.
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.
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.
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.
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.
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). http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf.
Akiyama H, Miyazono H, Tsurumaru M, Hashimoto C, Kawamura T. Use of the stomach as an esophageal substitute. Ann Surg. 1978;188:606–10.
Udagawa H, Ueno M, Kinoshita Y. Rationale for video-assisted radical esophagectomy. Gen Thorac Cardiovasc Surg. 2009;57:127–31.
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.
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.
Bjorkman DJ, Kimmey MB. Non steroidal anti-inflammatory drugs and gastrointestinal disease: pathophysiology, treatment and prevention. Dig Dis. 1995;13(2):119–29.
Scott G, Susan F. Use of intravenous acetaminophen in the treatment of postoperative pain. J Peri Anesthesia Nurs. 2011;26(2):74–80.
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.
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.
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.
Acknowledgements
We thank Dr. Erika Ohkura for her English proofreading of our manuscript.
Author information
Authors and Affiliations
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.
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Ohkura, Y., Shindoh, J., Ueno, M. et al. A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis. Surg Today 48, 502–509 (2018). https://doi.org/10.1007/s00595-017-1616-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-017-1616-5