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Meta-Analysis
. 2021 Apr-Jun;25(2):e2020.00104.
doi: 10.4293/JSLS.2020.00104.

The Efficacy of Acetominophen for Total Laparoscopic Hysterectomy

Greg J Marchand  1 , Ali Azadi  2 , Katelyn Sainz  1 , Ahmed Masoud  1 , Sienna Anderson  1 , Stacy Ruther  1 , Kelly Ware  1 , Sophia Hopewell  1 , Giovanna Brazil  1 , Alexa King  1 , Jannelle Vallejo  1 , Kaitlynne Cieminski  1 , Anthony Galitsky  1 , Robert Osipov  1 , Allison Steele  3 , Jennifer Love  3
Affiliations
Meta-Analysis

The Efficacy of Acetominophen for Total Laparoscopic Hysterectomy

Greg J Marchand et al. JSLS. 2021 Apr-Jun.

Abstract

Objective: Despite limited data, acetaminophen, along with other agents, is commonly included in enhanced recovery after surgery (ERAS) protocols following laparoscopic hysterectomy. We aimed to systematically review the efficacy of acetaminophen on the management of postoperative pain after laparoscopic hysterectomy.

Methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases for relevant clinical trials investigating the role of acetaminophen in the management of pain after laparoscopic hysterectomy. We performed the risk of bias according to Cochrane's risk of bias tool. We performed the analysis of homogeneous data under the fixed-effects model during the analysis of heterogeneous data under the random-effects model. The primary outcome was the assessment of pain score after 2, 6, 12, and 24 h.

Results: A total of 495 patients in 13 trials were included in our meta-analysis. Acetaminophen was not superior at reducing postoperative pain scores. Further analysis at progressive temporal points revealed no further significance; effect size at after 2 h (SMD = -0.020, 95% CI (-0.216; 0.176)), 6 h (SMD = -0.115, 95% CI (-0.312; 0.083)), 12 h (SMD = -0.126, 95% CI (-0.277; 0.025)), or 24 h (SMD = 0.063, 95% CI (-0.065; 0.191)). Pooled analysis was heterogeneous (P < 0.1); therefore, we conducted a sensitivity analysis yielding homogeneous results. The drug did not reduce opioid need (MD = -0.16, 95% CI (-2.39, 2.06), P = 0.89).

Conclusion: We conclude that acetaminophen is not beneficial for reducing pain after laparoscopic hysterectomy. Other alternatives have better results. Caution should be given to the inclusion of acetaminophen in ERAS protocols designed for laparoscopic hysterectomy, especially as a single agent or to reduce opioid consumption.

Keywords: Acetaminophen; ERAS; Enhanced recovery after surgery; Hysterectomy; Pain.

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Figures

Figure 1.
Figure 1.
Risk of bias graph.
Figure 2.
Figure 2.
PRISMA flow diagram.
Figure 3a.
Figure 3a.
Summary of quality assessment.
Figure 3b.
Figure 3b.
Quality assessment of included trials.
Figure 3b.
Figure 3b.
Quality assessment of included trials.
Figure 3b.
Figure 3b.
Quality assessment of included trials.
Figure 3b.
Figure 3b.
Quality assessment of included trials.
Figure 3c.
Figure 3c.
Funnel plot of sources of bias.
Figure 4a.
Figure 4a.
Pain Score SMD - pooled analysis.
Figure 4b.
Figure 4b.
Pain score SMD sensitivity analysis -2 hours.
Figure 4c.
Figure 4c.
Pain score SMD sensitivity analysis - 6 hours.
Figure 4d.
Figure 4d.
Pain score SMD sensitivity analysis - 12 hours.
Figure 4e.
Figure 4e.
Pain score SMD sensitivity analysis -24 hours.
Figure 5.
Figure 5.
Morphine consumption after 24 hours.
See this image and copyright information in PMC

References

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