EFFECTIVENESS OF INTRAVENOUS ACETAMINOPHEN ADMINISTRATION IN THE POSTOPERATIVE PAIN MANAGEMENT OF THE CESAREAN SECTION PATIENT

Abstract

Intravenous (IV) acetaminophen has been used internationally as part of a multimodal approach to pain management for general surgeries and some post cesarean sections.  In the case of post cesarean pain management, there is little evidence to support its use. The purpose of this evidenced-based literature review is to determine whether IV acetaminophen reduces opioid requirements for elective cesarean sections with neuraxial anesthesia. Google Scholar, CINAHL, PubMed, Cochrane, and Medline were searched. Articles addressing IV acetaminophen and cesarean section with neuraxial anesthesia were included. Outcome measurements were specific for postoperative opioid requirements, pain control satisfaction and visual analog scores. The literature review resulted in three randomized controlled trials with a total of 225 patients, of which 112 received IV acetaminophen. Two studies used fentanyl, and one used morphine. All articles found IV acetaminophen improved outcomes; three articles suggested that IV acetaminophen in combination with a nonsteriodal anti-inflammatory drug was more effective. Analysis of the evidence revealed IV acetaminophen is a valuable component of multimodal therapy in the reduction of post cesarean opioid requirements. Based on the current body of evidence, we can reasonably recommend IV acetaminophen for elective cesarean section patients using neuraxial anesthesia.