TY - JOUR
T1 - The Efficacy and Safety of Acetaminophen in Total Joint Arthroplasty
T2 - Systematic Review and Direct Meta-Analysis
AU - Fillingham, Yale A.
AU - Hannon, Charles P.
AU - Erens, Greg A.
AU - Mullen, Kyle
AU - Casambre, Francisco
AU - Visvabharathy, Vidya
AU - Hamilton, William G.
AU - Della Valle, Craig J.
N1 - Funding Information:
The authors would like to thank the American Association of Hip and Knee Surgeons for providing funding for this study. The authors would like to thank Jayson Murray from the American Academy of Orthopaedic Surgeons Clinical Quality and Value Department for his assistance with oversight of the quality assessment, data extraction, and statistical analysis. Finally, they thank the leadership of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, the American Society of Regional Anesthesia and Pain Medicine, the Hip Society, and the Knee Society for help with organizational support.
Publisher Copyright:
© 2020
PY - 2020/10
Y1 - 2020/10
N2 - Background: Oral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published prior to September 2019 on acetaminophen in primary TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of acetaminophen. Results: In total, 1287 publications were critically appraised yielding 17 publications representing the best available evidence for analysis. Oral and IV acetaminophen demonstrates the ability to safely reduce postoperative pain and opioid consumption during the inpatient hospital stay. No evidence was available to assess the efficacy and safety of oral acetaminophen after discharge. Conclusion: Moderate evidence supports the use of oral and IV acetaminophen as a non-opioid adjunct for pain management during the inpatient hospitalization. Strong evidence supports the safety of oral and IV acetaminophen when appropriately administered to patients undergoing primary TJA. Although there is lack of robust evidence for use of acetaminophen following discharge, it remains a low-cost and low-risk option as part of a multimodal pain regimen.
AB - Background: Oral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published prior to September 2019 on acetaminophen in primary TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of acetaminophen. Results: In total, 1287 publications were critically appraised yielding 17 publications representing the best available evidence for analysis. Oral and IV acetaminophen demonstrates the ability to safely reduce postoperative pain and opioid consumption during the inpatient hospital stay. No evidence was available to assess the efficacy and safety of oral acetaminophen after discharge. Conclusion: Moderate evidence supports the use of oral and IV acetaminophen as a non-opioid adjunct for pain management during the inpatient hospitalization. Strong evidence supports the safety of oral and IV acetaminophen when appropriately administered to patients undergoing primary TJA. Although there is lack of robust evidence for use of acetaminophen following discharge, it remains a low-cost and low-risk option as part of a multimodal pain regimen.
KW - acetaminophen
KW - pain management
KW - systematic review and meta-analysis
KW - total hip arthroplasty
KW - total joint arthroplasty
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85086506663&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2020.05.037
DO - 10.1016/j.arth.2020.05.037
M3 - Article
C2 - 32563592
AN - SCOPUS:85086506663
SN - 0883-5403
VL - 35
SP - 2715
EP - 2729
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 10
ER -