Intravenous acetaminophen reduces the length of intubation and rescue analgesics in intensive care unit patients after cardiovascular surgery in Japan: A retrospective analysis

Asahiko Higashitsuji; Yasutomo Tomioka; Tomoaki Tanabe; Nobuko Ami; Imun Tei

doi:10.5055/jom.2023.0786

Authors

Asahiko Higashitsuji, MSN, PHN, RN https://orcid.org/0000-0001-6784-9015
Yasutomo Tomioka, RN
Tomoaki Tanabe, MD
Nobuko Ami, RN
Imun Tei, MD

DOI:

https://doi.org/10.5055/jom.2023.0786

Keywords:

cardiology, pain management, acetaminophen, opioid, surgery

Abstract

Objective: After cardiovascular surgery, analgesic and sedative management in the intensive care unit (ICU) significantly affects short- and long-term outcomes of patients. This study aimed to clarify the impact of opioid reduction after acetaminophen administration on the length of intubation and rescue analgesic use after cardiovascular surgery.

Design: This was a case–control study.

Setting: This study was conducted in the ICU of a cardiovascular hospital.

Participants: Datasets of 556 post-cardiac surgery participants were collected; for final analyses, 266 participants were selected by propensity score matching. Equality between the intervention and comparison groups was ensured by calculating the standardized difference and difference test.

Interventions: The intervention group was treated with the multimodal analgesic sedation protocol.

Main outcome measure: The primary outcomes were the length of intubation and use of rescue analgesics.

Results: The intervention group demonstrated a decreased total opioid consumption (460.0 vs 580.0 mcg, effect size [ES] = –0.178), opioid administration time (1,130.0 vs 2,070.0 minutes, ES = –0.306), and sedative administration time (955.0 vs 1,577.0 minutes, ES = –0.354). Moreover, the protocol resulted in decreased duration of ventilation (990.0 vs 1,057.5 minutes, ES = –0.140) and reduced need for rescue analgesics, including flurbiprofen axetil (3.5 vs 34.5 percent, ES = –0.392) and loxoprofen sodium (19.5 vs 48.1 percent, ES = –0.284).

Conclusion: This study suggested that acetaminophen reduces opioid use and improves patient outcomes after cardiovascular surgery. Moreover, this research provides essential information for developing analgesic management strategies to reduce opioid consumption in patients after cardiovascular surgery.

Author Biographies

Asahiko Higashitsuji, MSN, PHN, RN

PhD Student, Graduate School of Nursing, Chiba University, Chiba City, Chiba, Japan

Yasutomo Tomioka, RN

Staff Nurse, Department of Cardiology, Ayase Heart Hospital, Adachi-ku, Tokyo, Japan

Tomoaki Tanabe, MD

Doctor, Department of Cardiology, Ayase Heart Hospital, Adachi-ku, Tokyo, Japan

Nobuko Ami, RN

Director of Nursing Service Department, Department of Cardiology, Ayase Heart Hospital, Adachi-ku, Tokyo, Japan

Imun Tei, MD

Director of Hospital, Department of Cardiology, Ayase Heart Hospital, Adachi-ku, Tokyo, Japan

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