IV Apap: Nonsalicylate Antipyretic

IV Tylenol general information
IV APAP is a nonopioid analgesic and nonsalicylate antipyretic. 1 In 2010 it was approved for use in the United States to manage mild to moderate pain, moderate to severe pain coupled with opioids, and as an antipyretic.1
ADJUNCT
SE OF OPIOIDs: Opioids side effects include itching, constipation, nausea, and vomiting, respiratory depression.21 The consequences of these side effects can be additional medications to manage, increased cost, decreased patient satisfaction, and increased length of stay.21
A review of the literature was performed using the following keywords: acetaminophen, intravenous, paracetamol, postoperative pain, and analgesia.
IV acetaminophen compared to oral route has shown to have a superior
This includes adding around the clock NSAIDS, acetaminophen, or COXIBs, and considering regional blocks, and local anesthetics. 25

This paper will explore the use of IV APAP and determine if APAP’s effect on opioid consumption.
Study 11:
Preemptive administration of IV Paracetamol before cesarean section showed statistically significant differences in lower blood pressure and heart rate (p<0.05) in subjects receiving Lornoxicam.18 Both of these drugs should be considered while coupling with opioids to manage pain. As a NSAID, Lornoxicam does come with the increased risk of bleeding which should be considered.18

Study 17
Faiz et al. compared IV APAP to Ketamine in managing post-operative pain in hysterectomies. It was shown that the IV APAP group had statistically lower pain scores and required less supplemental opioid compared to subjects given Ketamine. It is of note that neither group had a difference in adverse reactions including nausea, vomiting, dizziness, or hemodynamics.17
Study
performed a retrospective case-control study of patients undergoing knee arthroplasty patients and the effect of IV APAP on opioid use and LOS. IV APAP did not significantly decrease postoperative opioid usage and both groups had no difference in length of stay.
The design of this study does have questionable flaws which question its validity. The classes are unbalanced: 25 subjects in the experimental group and 75 subjects in control group. No controls were made for chronic pain, and the authors did not mention if any of the patients in the APAP group had chronic pain or what percentage present in either group. These facts could significantly alter results as chronic pain patients usually require differing dosing than non.
Lastly in critique, the experimental group received varying doses of APAP; some patients one dose, other multiple. Inclusion criteria for the APAP group included at least a single dose of APAP following surgery. There was no standard dose of APAP given to the patients. The experimental design is flawed, the authors did not control to ensure similar testing groups nor did they standardize the independent test group, therefore causality cannot be assumed.
Study