Effectiveness of postoperative intravenous acetaminophen (Acelio) after gastrectomy A propensity score-matched analysis

The aim of this study was to investigate the efficacy of postoperative scheduled intravenous acetaminophen to reduce the opioid use and enhance recovery after gastrectomy. Opioid use is reportedly associated with delayed recovery of gastrointestinal (GI) peristalsis and postoperative nausea/vomiting (PONV) despite of acceptable efficacy for pain control. Of 147 and 96 consecutive patients who underwent gastrectomy for gastric cancer before and after introduction of postoperative scheduled intravenous acetaminophen, propensity score matched population was created and short-term clinical outcomes were compared. Significant defervescence was demonstrated in Acetaminophen group (A-group) compared with control group (C-group) during the perioperative period (P<0.001), whereas no significant difference was observed in postoperative inflammatory parameters. The incidence of postoperative complications was similar between the groups. The number of patient-controlled analgesia (PCA) pushes was significantly reduced in the A-group (P=0.007) and the frequency of use of other nonopioid analgesics was also significantly reduced in the A-group (P<0.001). Both daily and cumulative opioid use was significantly reduced in the A-group (P<0.001). The time to first flatus and defecation was decreased in the A-group (P<0.001 and P=0.038, respectively). The incidence of PONV was significantly reduced from 26.0% to 12.5% after introduction of intravenous acetaminophen (P=0.017), and hospital stay tended to be decreased in the A-group (13.2 vs 14.7 days, P=0.069) Postoperative scheduled intravenous acetaminophen decreased opioid use and may be associated with enhanced recovery after gastrectomy.