The Role of Intravenous Acetaminophen in Post-Operative Pain Control in Head and Neck Cancer Patients

Presentation: AHNS029
Topic: Pharynx / Larynx Cancer
Type: Oral
Date: Wednesday, April 18, 2018
Session: 2:20 PM - 3:10 PM Larynx/Pharynx
Authors: Erin J Smith, MD, MS1, Jessica Lange, MD2, Cindy Moore, MD1, Lana Jackson, MD1, Isaam Eid, MD3, Jesus Monico, MPH, MS1
Institution(s): 1University of Mississippi Medical Center, 2Ear Nose and Throat Specialists, Lexington, Kentucky, 3University of Kansas Medical Center

Importance  There have been multiple studies looking at improving pain control in patients undergoing major head and neck surgery.  Traditionally postoperative pain management in these patients has been dominated by opiates.  To date, there is no published literature that has investigated the role of intravenous acetaminophen for postoperative pain control after surgical resection of head and neck cancers.

Objective  To investigate the role of intravenous acetaminophen for alleviation of postoperative pain after surgical resection of head and neck cancers.

Design, Setting, and Participants  A single center prospective study was conducted between April 2016 and May 2017, which included 48 participants who underwent surgical resection of head and neck cancer and postoperatively received intravenous Tylenol (1 gram every 6 hours for 4 doses), in conjunction with the standard opioid PCA and other prn narcotics.  These patients were compared to a similar historical group of 51 patients who underwent surgery from January 2014 to March 2015 and received the standard opioid PCA and prn narcotics.

Main Outcomes and Measures  The main outcome measures included (1) averaged 8 hour pain scores over the first 24 hours, (2) total amount of narcotics, measured in morphine equivalents (MEs), in 8 hour intervals over the first 24 hours, and (3) total number of PCA attempts in 8 hour intervals over the first 24 hours. A secondary outcome measure was length of stay.  Statistical measures included descriptive analysis and gamma regression, with covariate adjustments for age at time of surgery, sex, and race.

Results  Patients in the acetaminophen group received less total narcotics in the first 8 hours after surgery compared to non-acetaminophen group (13.5 ± 13.3 vs. 22.5 ±21.5 MEs, p = 0.014).  There was no significant difference in the total narcotics received in the second and third 8 hour intervals; however the total IV MEs received over 24 hours approached significance (44.8 ±38.6 MEs in acetaminophen group vs. 64.7 ± 60.2 MEs in the non-acetaminophen group, p = 0.055). Patients in the acetaminophen group had a decreased length of stay compared to the non-acetaminophen group (7.8 ± 4.6 vs. 10.6 ± 7.6 days, p=0.03).  There was no difference in the PCA attempts between the two groups. These associations held true after covariate adjustments for age, sex, and race.

Conclusions and Relevance  This study shows that intravenous acetaminophen may play a role in reducing the total narcotic requirement in the first 8 hours after surgery and potentially contribute to decreased length of stay and therefore decreased cost to the patient and hospital overall.  Future research should be aimed at comparing these groups in a randomized control study/setting.