Date of Graduation

Summer 8-13-2016

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers

Second Advisor

Brent Norris

Abstract

Background: Hysterectomy is a common surgery amongst females and is occasionally considered a same-day outpatient surgery. There is a lack of adequate postoperative pain control thus leading to extended use of postoperative opioid use. As a result, in addition to other postoperative side effects, patients suffer from adverse side effects of opioid use, including sedation, respiratory depression, constipation, nausea, and pruritus. This indirectly prolongs patients’ hospital stay and recovery. There have been recent studies suggesting non-opioids, such as acetaminophen, could decrease opioid use postoperatively. The aim of this review is to evaluate whether preoperative acetaminophen use will decrease postoperative opioid use within the first 24-hours after a hysterectomy.

Methods: An exhaustive literature search of available medical literature was performed using MEDLINE-Ovid, Web of Science, and CINAHL-Ebscohost. Keywords used included: preoperative care and acetaminophen. Relevant articles were assessed for quality using the GRADE system.

Results: Nine articles were found and reviewed for relevancy. Two studies qualified for both the inclusion and exclusion criteria for this review. Both studies were randomized controlled trials. One study used 76 subjects with the Pfannestiel incision and the other used 90 subjects with the laparoscopic method. Both studies revealed decreased use of opioid consumption within the first 24-hours of surgery. Additionally, both studies revealed patients had decreased incidents of PONV and pruritus.

Conclusion: Preoperative acetaminophen showed significantly lower use of opioid postoperatively in both open and laparoscopic hysterectomies. Although the mechanism of action of acetaminophen is unclear, there is evidence of efficacy and safety when acetaminophen is used for pain, especially in comparison to the risks of opioid use. Use of preoperative acetaminophen should be strongly considered with both open and laparoscopic hysterectomies to decrease not only opioid consumption but also the adverse side effects of its use. Studies in the future should use randomized controlled trials with larger sample sizes, different surgical modalities, explore different acetaminophen doses, and varying postoperative opioids to further examine the efficacy and acceptability of preoperative acetaminophen use.

Keywords: Preoperative care and acetaminophen

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