Acetaminophen Use for Preemptive Analgesia


Name: Elaine Walizer

Rank: LTC, USA

Organization: Henry M. Jackson Foundation

Performance Site: Walter Reed Army Medical Center, Washington, DC

Year Published: 1996

Abstract Status: Final


For a multitude of reasons, and despite standard prescriptives of postoperative analgesia, unreasonable surgical pain remains a problem in many healthcare settings (Ephraim, 1990). Researchers need to continually investigate the mechanisms by which we deliver pain relief. The phenomenon of preventing central sensitization or "preemptive analgesia" is very promising. The use of acetaminophen for preemptive analgesia has been limited in its use. The mechanism by which acetaminophen produces analgesia has been elusive. But more recently, there is evidence to suggest that acetaminophen acts as an antagonist to NMDA receptors which are important to the initiation and maintenance of central sensitization. If the NMDA receptors can be antagonized, central sensitization may be inhibited. If acetaminophen antagonizes NMDA receptors as the research seems to indicate, it may be an effective preemptive analgesic. The purpose of this study is to conduct a placebo controlled clinical trial of oral acetaminophen as an effective preemptive analgesic in elective abdominoplasties. It may also provide significant information on, not only its efficacy, but, also any opioid sparing effects. The Gaston-Johannson Pain-O-Meter (POM) is a clinically useful tool in assessing the multidimensional aspects of pain. It will be used to assess the patient's self-report of pain. The Interference of Daily Activities Scale will be used to measure the interference of pain with activities associated with daily living. An Overall Satisfaction with Pain Management Scale will measure the patient's satisfaction with pain management. Opioid sparing will be measured by total dose of opioid use, occurrence of opioid side effects and length of stay. The proposed research could reduce the use and cost of expensive analgesics, reduce opioid side effects, improve postoperative performance expectations, improve patient satisfaction with pain management, but, also change the practice of anesthesia.


Final report is available on NTRL: