Retrospective Pharmacoeconomic Analysis of Perioperative use of Intraveneous Acetaminophen

Background: Pain is a growing public health problem that costs society $560–$635 billion annually. Using a potent analgesic to alleviate the postoperative pain may result in substantial analgesia and enhanced patient satisfaction. The benefits are often challenging to decipher in terms of cost reduction and necessity to improve quality of care. Furthermore, commonly used mediations like non–steroidal anti–inflammatory drugs (NSAIDs) and opioids are associated with potentially adverse side effects. The recent release of intravenous (IV) acetaminophen in the United States has raised concerns related to its analgesic efficiency and cost–effectiveness. The aim of this retrospective chart review is to study the perioperative use of IV acetaminophen and its potential for cost effectiveness when used in this setting. Methods: We performed a retrospective cohort study of all patients who had undergone surgeries at Drexel University College of Medicine⁄Hahnemann University hospital from September 2011 to February 2012. This review evaluated cost of IV acetaminophen per patient, cost of other analgesics (NSAIDs, Opioids) and total cost of analgesics used per patient. In addition, we evaluated visual analog scores (VAS), length of hospital stay, global patient satisfaction, and opioid related side–effect. The groups were compared with Chisquared test and p–values were reported. Results: Analysis of the retrospective data showed that the majority of the study population had were ASA grade II (51%) and 74% of the patients received acetaminophen as an preoperative analgesic. All patients, 80 (100%) received intraoperative analgesics which included a combination of drugs such as fentanyl, morphine and hydromorphone. In addition, postoperatively, 36 (45%) did not receive analgesia and 19 (24%) had regional anesthetic nerve blocks. Seventy one (88%) of patients did not have any adverse events; post–operative nausea was noticed in 5 (6.25%) patients and vomiting in 1 (1.25%) of patients. Conclusion: This retrospective pharmacoeconomic review suggests that the IV formulation of acetaminophen increased the total cost of analgesics used perioperatively. Although, it may be cost effective since there is a less total opioid consumption and subsequently fewer opioid related side effects and potentially decreased length of stay. Further complete randomized controlled studies are needed to delineate the role and cost effectiveness of multimodal analgesia with the use of IV acetaminophen.