Correspondence  |   March 2019
Opiates and IV Acetaminophen
Author Notes
  • University of Tennessee Health Science Center, Memphis, Tennessee. jsteadm5@uthsc.edu
  • (Accepted for publication November 16, 2018.)
    (Accepted for publication November 16, 2018.)×
Article Information
Correspondence
Correspondence   |   March 2019
Opiates and IV Acetaminophen
Anesthesiology 3 2019, Vol.130, 513-514. doi:10.1097/ALN.0000000000002568
Anesthesiology 3 2019, Vol.130, 513-514. doi:10.1097/ALN.0000000000002568
I read with keen interest the article by Wasserman et al.,1  “Impact of Intravenous Acetaminophen on Perioperative Opioid Utilization and Outcomes in Open Colectomies,” in the July issue of Anesthesiology. Using billing codes to determine opiate use in 602 disparate hospitals in various states without knowing precisely what protocols are used renders the conclusion that IV acetaminophen has no important impact on postoperative opioid use in question. Hospitals with excellent compliance with Enhanced Recovery After Surgery Group protocols obtain decreases in opiate use. However, compliance with Enhanced Recovery After Surgery protocols is highly variable from hospital to hospital, let alone from practitioner to practitioner. For instance, some physicians routinely give patients an opiate patient-controlled analgesia in addition to IV acetaminophen as part of a multimodal protocol when they assume a patient is going to have very high demands versus oral for those they assume will not. If nursing staff receive scheduled orders for nonsteroidal antiinflammatory drugs or IV acetaminophen but do not deliver them in a timely fashion, the patient may get behind in pain control, thus necessitating rescue opiate. In states with high rates of chronic opiate users, the results will skew to no impact for IV acetaminophen. For that matter, if a patient is given an opiate patient-controlled analgesia but does not use it, the billing codes will still reflect opiate given, when in fact, the patient may not have used it. In hospitals where thoracic epidurals are not routinely used, or if individual patients decline or cannot receive thoracic epidural, opiates become the mainstay treatment for severe pain. Patients who are content with oral acetaminophen are more likely to have either high pain tolerance or negative personal convictions about taking opiates. Those with low tolerance or already taking chronic opiates will likely require potent opiates postoperatively.