Introduction: Drug overdose deaths continue to increase in the United States. The acute use of opioids in the post-operative setting is a factor in the development of long term opioid dependence. In light of these concerns, there is increased interest among the surgical community in enhanced recovery after anesthesia using multimodal analgesia (MMA) techniques. A 2016 study by Hanson et al. demonstrated that peri-operative intravenous acetaminophen use was associated with shorter hospital length of stay and decreased opioid requirements in patients who underwent orthopedic surgery. Despite the frequency of thyroid & parathyroid surgeries, there is limited data in the literature to guide post-operative pain management. In our institution, recent studies have shown that opioids have been overprescribed at discharge relative to in-patient requirements after head and neck endocrine surgery. In this study, we seek to determine if the administration of peri-operative intravenous acetaminophen affects pain severity and post-operative opioid consumption in parathyroid and thyroid surgeries.
Study Design:Retrospective chart review
Setting:Academic university hospital.
Subjects and Methods: Medical records of 237 adult patients undergoing thyroid and parathyroid surgery were included. Exclusion criteria included patients under the age of 18, undergoing combination procedures, and undergoing lateral neck dissections. Clinicopathologic data was collected including operation, perioperative pain medications given during the hospital stay, length of stay, and postoperative pain scores.
Results: A single dose of 1 gm IV acetaminophen was given in the operating room or the recovery room in 123/237 (52%) of patients. The maximum pain score in patients who received IV acetaminophen averaged 5.72 (range 0-10) and was not significantly different from patients who did not receive IV acetaminophen 5.74 (range 0-10). Pain scores at discharge in the IV acetaminophen group (2.74, range 0-7) were not significantly different than in the non-IV acetaminophen group (2.43, range 0-8). Morphine milligram equivalents per day during the hospital stay were also no different in the IV acetaminophen group (24.97, range 0-109) and the non-IV acetaminophen group (25.87, range 0-201).
Conclusion:There is limited literature on post-operative pain management in head and neck endocrine surgery. In our population, the data does not show that IV acetaminophen affects patient reported pain or opioid use in the immediate peri-operative period. This is relatively unexpected given the support in other surgical literature for the use of IV acetaminophen in MMA for post-operative analgesia. Our results may suggest that the level of pain following endocrine surgery is low enough that IV acetaminophen is not of similar benefit.