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Intravenous Versus Oral Acetaminophen for Pain Control in Neurocritical Care Patients

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Abstract

Background

Acetaminophen (APAP) is used in neurocritical care (NCC) patients for analgesia without sedation or antiplatelet activity. Research suggests that intravenous (IV) APAP produces earlier and higher serum levels compared to oral (PO) APAP. This retrospective study evaluates the associated analgesic effects of IV and PO APAP and use of adjunctive opioids in NCC patients with moderate-severe pain.

Methods

Patients admitted to the neuroscience intensive care unit (NSICU) between May 2012 and April 2013 who received ≥1 dose of IV APAP were included in the study. IV and PO APAP doses administered with a predose pain score ≥4 within 1 h of dosing were compared. Pain intensity difference (PID) was calculated as the change between the pain score prior to each dose and scores at 30 min, 1, 2, 3, and 6 h postdose. Pre- and postdose morphine milligram equivalents (MME) were also calculated.

Results

309 NSICU patients received 459 doses of IV and 440 doses of PO APAP meeting our inclusion criteria. The PID at 30 min postdosing was significantly higher among those receiving IV APAP compared to those receiving PO APAP (p = 0.003). No significant difference in PID was seen at 1, 2, 3, and 6 h; and there was no significant difference in pre- or postdose MME between the two groups.

Conclusion

IV APAP was more effective than PO APAP at relieving pain within 30 min of dosing, but this difference was not sustained over 6 h. Further studies are needed to assess the benefits of this rapid onset of action.

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Funding

This investigator-initiated study was funded by Mallinckrodt Pharmaceuticals.

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Authors and Affiliations

  1. Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA

    Dan C. Nichols, Pramit A. Nadpara, Perry D. Taylor & Gretchen M. Brophy

  2. Virginia Commonwealth University Medical Center, Richmond, VA, USA

    Dan C. Nichols, Perry D. Taylor & Gretchen M. Brophy

  3. Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA

    Gretchen M. Brophy

Authors
  1. Dan C. Nichols
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  2. Pramit A. Nadpara
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  3. Perry D. Taylor
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  4. Gretchen M. Brophy
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Corresponding author

Correspondence to Gretchen M. Brophy.

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Conflicts of Interest

Gretchen Brophy is a consultant and speaker for Mallinckrodt Pharmaceuticals.

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Nichols, D.C., Nadpara, P.A., Taylor, P.D. et al. Intravenous Versus Oral Acetaminophen for Pain Control in Neurocritical Care Patients. Neurocrit Care 25, 400–406 (2016). https://doi.org/10.1007/s12028-016-0289-z

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  • DOI: https://doi.org/10.1007/s12028-016-0289-z

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