In hospital settings, many medications have to be administered intravenously (IV) because of patient needs. A recent study found that in one medication, going IV versus oral administration did not show much of a benefit.
The study, conducted by Mount Sinai Hospital researchers was the first of its kind to look at IV acetaminophen in colorectal procedures. In these procedures, the drug is administered to control minor pain, but also to "get ahead" of post-procedure pain and hopefully reduce the use of opioids.
The study which is published in the July issue of Anesthesiology didn't show a benefit to the IV use of acetaminophen when it was compared to oral use. Lead investigator Jashvant Poeran, MD is also an Assistant Professor of Population Health and Health Science Policy at the Icahn School of Medicine at Mount Sinai. He explained, "With any new drug that is introduced to the U.S. market, it is very important to monitor how it is used and if this results in the desired outcomes. Our study results do not support the routine use of IV acetaminophen."
The IV version of acetaminophen was first introduced in the United States in 2010. Used mostly in minor surgical procedures, there was a significant uptick in its use once the opioid crisis was evident. Acetaminophen is often a substitute for more powerful drugs because it produces fewer side effects and avoids possible drug dependence. With the increased use, there was an accompanying price hike, when the drug's price increased by 300% in 2014. That's when many hospitals and physicians started to look at any possible benefit that could justify a high cost.
The specifics of the study are as follows: The data included 181,640 patients who had open colectomy surgery from 2011 to 2016 in 602 hospitals nationwide. The procedure was used because it's commonly found that patients who have this surgery, do not always tolerate oral medications. The researchers found that overall, about 25% of patients were given IV acetaminophen, most commonly in one dose, on the day of surgery. They found that postoperative pain was not significantly reduced in the patients receiving it. Patients who got the drug in an oral dose seemed to have the same amount or even less pain.
This could be partially due to the way the IV version was used. It's possible that more than one dose is necessary, but that increases the cost factor. An IV dose of acetaminophen is much more expensive than an oral dose, and that expense doubles if more must be used. The authors noted that further research should look at appropriate dosing amounts for those patients who cannot tolerate oral administration. Dr. Poeran elaborated, "It is important that we that we identify optimal dosing strategies and patients that are most likely to benefit from this relatively new drug. Especially among patients undergoing colorectal surgery, there may be a group of patients that do not tolerate oral medications. This may be less of an issue among patients undergoing other types of surgery, such as hip and knee replacement surgery, and these results further emphasize a more targeted approach in determining who benefits most."
The research team is now collecting data from other types of surgeries that include orthopedic procedures and joint replacement surgery. The video below has more information.