According to statistics from the CDC, the number of all opioid prescriptions dropped roughly 42% from 2012 to 2019, a year when overdose deaths hit a new peak of 71,327. The top four implicated drugs—illicit fentanyl and its analog, heroin, cocaine and methamphetamine—were involved in far more deaths than any prescription opioid. Yet surgeons are repeatedly encouraged to use IV acetaminophen—which is simply Tylenol—to treat postoperative pain in order to spare their patients the risk for addiction.
The literature is jam‐packed with studies about the effect, or lack thereof, of IV Tylenol in controlling pain from a variety of surgical procedures. But virtually all of these are retrospective studies, which are inferior to controlled prospective studies with predetermined end points and a control group (usually placebo). Now there’s a randomized, double‐blind, placebo‐controlled trial—the gold standard of clinical trials—and if this doesn’t disabuse doctors from prescribing acetaminophen for postoperative pain, nothing will. Lead author Alparslan Turan, MD, and colleagues published the results in JAMA last July (2020;324:350–358) and it was recently summarized in General Surgery News.
The Cleveland Clinic group enrolled 580 participants, all of whom were scheduled for abdominal surgery. Half of the participants received 1 gram of IV Tylenol; the rest got a saline placebo. Doses of each were given every six hours for up to 48 hours (the dosing arm was less than 48 hours when the patient was discharged before that time).