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