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Scheduled intravenous acetaminophen versus nonsteroidal anti-inflammatory drugs (NSAIDs) for better short-term outcomes after esophagectomy for esophageal cancer

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Abstract

Purpose

To evaluate the effect of scheduled intravenous acetaminophen administration versus nonsteroidal anti-inflammatory drugs on postoperative pain and short-term outcomes after esophagectomy.

Methods

The subjects of this study were 150 consecutive patients who underwent esophagectomy for esophageal cancer. Seventy-seven patients received scheduled intravenous acetaminophen and the other 73 received NSAIDs enterally for postoperative pain management. We compared the postoperative pain and short-term outcomes between the groups. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to control for selection bias.

Results

The visual analog scale (VAS) of postoperative pain was lower in the acetaminophen group than in the NSAIDs group, based on the mean values of chest VAS on postoperative days (PODs) 0, 4, 5, and 6 and the mean values of abdomen VAS on PODs 4, 5, and 6. The incidence of anastomotic leakage and postoperative delirium was lower in the acetaminophen group than in the NSAIDs group (anastomotic leakage, odds ratio (OR) 0.3, p = 0.01; postoperative delirium, OR 0.19, p < 0.01).

Conclusion

Scheduled intravenous acetaminophen administration is effective and feasible for the postoperative pain management of patients undergoing esophagectomy and may be associated with a lower incidence of anastomotic leakage and postoperative delirium.

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References

  1. Sakatoku Y, Fukaya M, Miyata K, Itatsu K, Nagino M. Clinical value of a prophylactic minitracheostomy after esophagectomy: analysis in patients at high risk for postoperative pulmonary complications. BMC Surg. 2017;17(1):120.

    Article  Google Scholar 

  2. Visser E, Marsman M, van Rossum PSN, Cheong E, Al-Naimi K, van Klei WA, et al. Postoperative pain management after esophagectomy: a systematic review and meta-analysis. Dis Esophagus. 2017;30(10):1–11.

    Article  Google Scholar 

  3. Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014;259(3):413–31.

    Article  Google Scholar 

  4. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg. 2017;152(7):691–7.

    Article  Google Scholar 

  5. Gupta A, Bah M. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep. 2016;20(11):62.

    Article  Google Scholar 

  6. Modasi A, Pace D, Godwin M, Smith C, Curtis B. NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis. Surg Endosc. 2019;33(3):879–85.

    Article  Google Scholar 

  7. Bhangu A, Singh P, Fitzgerald JE, Slesser A, Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg. 2014;38(9):2247–57.

    Article  Google Scholar 

  8. Ohkura Y, Shindoh J, Ueno M, Iizuka T, Haruta S, Udagawa H. A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis. Surg Today. 2018;48(5):502–9.

    Article  Google Scholar 

  9. Kitagawa H, Namikawa T, Iwabu J. Scheduled intravenous acetaminophen for postoperative management of patients who had thoracoscopic esophagectomy for esophageal cancer. Anticancer Res. 2019;39(1):467–70.

    Article  Google Scholar 

  10. Gupta A, Jakobsson J. Acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective inhibitors: an update. Plast Reconstr Surg. 2014;134(4 Suppl 2):24S–31S.

    Article  CAS  Google Scholar 

  11. Miyata K, Fukaya M, Itatsu K, Abe T, Nagino M. Muscle sparing thoracotomy for esophageal cancer: a comparison with posterolateral thoracotomy. Surg Today. 2016;46(7):807–14.

    Article  Google Scholar 

  12. Kawai R, Abe T, Uemura N, Fukaya M, Saito T, Komori K, et al. Feeding catheter gastrostomy with the round ligament of the liver prevents mechanical bowel obstruction after esophagectomy. Dis Esophagus. 2017;30(6):1–8.

    Article  CAS  Google Scholar 

  13. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–44.

    Article  Google Scholar 

  14. Foster B, Twycross R, Mihalyo M, Wilcock A. Buprenorphine. J Pain Symptom Manage. 2013;45(5):939–49.

    Article  Google Scholar 

  15. Pasqualucci V, Tantucci C, Paoletti F, Dottorini ML, Bifarini G, Belfiori R, et al. Buprenorphine vs. morphine via the epidural route: a controlled comparative clinical study of respiratory effects and analgesic activity. Pain. 1987;29(3):273–86.

    Article  CAS  Google Scholar 

  16. McPherson ML. Demystifying opioid conversion calculations: a guide for effective dosing. 2nd ed. Bethesda: American Society of Health-System Pharmacists, Inc.; 2018.

    Google Scholar 

  17. Rice TW, Ishwaran H, Blackstone EH, Hofstetter WL, Kelsen DP, Apperson-Hansen C. Recommendations for clinical staging (cTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus. 2016;29(8):913–9.

    Article  Google Scholar 

  18. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  Google Scholar 

  19. Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34(28):3661–79.

    Article  Google Scholar 

  20. Smith HS. Perioperative intravenous acetaminophen and NSAIDs. Pain Med. 2011;12(6):961–81.

    Article  Google Scholar 

  21. Fjederholt KT, Okholm C, Svendsen LB, Achiam MP, Kirkegård J, Mortensen FV. Ketorolac and other NSAIDs increase the risk of anastomotic leakage after surgery for GEJ cancers: a cohort study of 557 patients. J Gastrointest Surg. 2018;22(4):587–94.

    Article  Google Scholar 

  22. Takeuchi M, Takeuchi H, Fujisawa DV, Miyajima K, Yoshimura K, Hashiguchi S, et al. Incidence and risk factors of postoperative delirium in patients with esophageal cancer. Ann Surg Oncol. 2012;19(12):3963–70.

    Article  Google Scholar 

  23. Fuchita M, Khan SH, Perkins AJ, Gao S, Wang S, Kesler KA, et al. Perioperative risk factors for postoperative delirium in patients undergoing esophagectomy. Ann Thorac Surg. 2019;108:190–5.

    Article  Google Scholar 

  24. Kawano T, Yamanaka D, Aoyama B, Tateiwa H, Shigematsu-Locatelli M, Nishigaki A, et al. Involvement of acute neuroinflammation in postoperative delirium-like cognitive deficits in rats. J Anesth. 2018;32(4):506–17.

    Article  Google Scholar 

  25. Graham GG, Scott KF, Day RO. Tolerability of paracetamol. Drug Saf. 2005;28(3):227–40.

    Article  CAS  Google Scholar 

  26. Subramaniam B, Shankar P, Shaefi S, Mueller A, O’Gara B, Banner-Goodspeed V, et al. Effect of intravenous acetaminophen vs placebo combined with propofol or dexmedetomidine on postoperative delirium among older patients following cardiac surgery: the DEXACET randomized clinical trial. JAMA. 2019;321(7):686–96.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Jiro Kawakami, Tetsuya Abe, Eiji Higaki, Takahiro Hosoi, Koji Komori, Seiji Ito & Yasuhiro Shimizu

  2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Jiro Kawakami, Masahide Fukaya & Masato Nagino

  3. Department of Nursing, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan

    Masahiro Nakatochi

  4. Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Masahiro Nakatochi

Authors
  1. Jiro Kawakami
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  2. Tetsuya Abe
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  3. Eiji Higaki
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  4. Takahiro Hosoi
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  5. Masahide Fukaya
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  6. Koji Komori
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  7. Seiji Ito
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  8. Masahiro Nakatochi
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  9. Masato Nagino
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  10. Yasuhiro Shimizu
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Corresponding author

Correspondence to Tetsuya Abe.

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Jiro Kawakami and his co-authors have no conflicts of interest to declare.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

Table 1 Conversion table of opioid dose.

595_2020_2001_MOESM2_ESM.xlsx

Analysis of the impact of intravenous acetaminophen vs. NSAIDs on postoperative complications and short-term outcomes with weighted logistic regression and adjustment for chemoradiotherapy.

Reasons for readmission within 30 days after discharge.

Standardized differences of independent

595_2020_2001_MOESM5_ESM.pptx

Supplementary Fig. 1. Assessment of postoperative pain using adjusted linear regression a. Daily trend of the mean value of chest VAS at rest in the acetaminophen group. b. Daily trend of the mean value of chest VAS at rest in the NSAIDs group. c. Daily trend of the mean value of abdomen VAS at rest in the acetaminophen group. b. Daily trend of the mean value of abdomen VAS at rest in the NSAIDs group.

Supplementary material 6 (PPTX 1068 kb)

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Kawakami, J., Abe, T., Higaki, E. et al. Scheduled intravenous acetaminophen versus nonsteroidal anti-inflammatory drugs (NSAIDs) for better short-term outcomes after esophagectomy for esophageal cancer. Surg Today 50, 1168–1175 (2020). https://doi.org/10.1007/s00595-020-02001-x

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  • DOI: https://doi.org/10.1007/s00595-020-02001-x

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