A Comparison of IV Versus PO Acetaminophen Postoperatively for Opioid Consumption After Cesarean Section
Lead SponsorMain Line Health
Indication/ConditionAcetaminophen Postoperative Pain Cesarean Section
Intervention/TreatmentAcetaminophen Acetaminophen ...
This randomized controlled study will compare narcotic consumption between two groups: patients that receive a perioperative dose of IV acetaminophen versus patients that receive a perioperative dose of oral liquid acetaminophen for scheduled cesarean section.
"Enhanced recovery" is an alternate management protocol described by a multi-modal, evidence based approach to peri-operative care, with the goal of accelerating recovery and return to normal activity after surgery. Results have shown stable pain control with a decrease in narcotic consumption, a quicker return of bowel function, and decreased length of hospital stay and cost with no change in level of patient satisfaction, morbidity, or readmission rate. An aspect of some alternate management protocols is the administration of acetaminophen.
The concentration of acetaminophen in cerebrospinal fluid (CSF) is directly proportional to the analgesic activity of acetaminophen. Acetaminophen relies on a high concentration gradient from the plasma to the CSF in order to passively diffuse into the central nervous system (CNS), its principal site of action. A 2012 study, comparing plasma and CSF pharmacokinetics of intravenous (IV), oral (PO), or rectal (PR) acetaminophen, concluded that IV administration of acetaminophen results in higher plasma and CSF concentration values. Therefore, IV acetaminophen produces better CNS penetration compared to PO or PR methods.
Acetaminophen liquid syrup
Flavored, non-medicated (placebo) liquid syrup
IV salt solution (non-medicated)
A single peri-operative dose of acetaminophen 1000 mg IV over 15 minutes after skin is closed.
A pre-operative liquid dose of acetaminophen 1000mg orally in the on-call to Operative Room.
Inclusion Criteria: Women age 18 or older Scheduled to undergo a cesarean section Exclusion Criteria: Existing diagnosis of chronic pain Need to undergo a vertical skin incision Aspartate Aminotransferase (AST) > 50, alanine aminotransferase (ALT) > 70 Platelets below 80,000 on admission Need to undergo general anesthesia Tubal ligation at time of Cesarean section Prior or known allergy to any of the medications being utilized in this study