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Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis

  • Song-bo Shi
  • Xing-bo Wang
  • Jian-min Song
  • Shi-fang Guo
  • Zhi-xin Chen
  • Yin Wang
Open Access
Systematic review

Abstract

Background

The efficacy of intravenous acetaminophen in multimodal pain management in patients undergoing total knee arthroplasty (TKA) is controversial. The purpose of this meta-analysis was to compare the efficacy of intravenous acetaminophen versus placebo in TKA.

Methods

Randomized controlled trials (RCTs) or retrospective cohort studies (RCSs) concerning related topics were retrieved from PubMed (1996–June 2018), Embase (1980–June 2018), and the Cochrane Library (CENTRAL June 2018). Any studies comparing intravenous acetaminophen with a placebo were included in this meta-analysis. Meta-analysis results were collected and analyzed by Stata 12.0. Subgroup analysis was performed according to the general characteristics of the patients.

Results

In total, the patients from six studies met the inclusion criteria. Our meta-analysis results indicated that compared with a control group, intravenous acetaminophen was associated with reductions in total morphine consumption and visual analogue scale (VAS) score at postoperative day (POD) 3. However, there was no significant difference in morphine consumption at POD 1 or in VAS at POD 1 or POD 2. Moreover, there was no significant difference in the length of hospital stay.

Conclusions

Based on our results, intravenous acetaminophen in multimodal management has shown better efficacy in pain relief at POD 3 and has morphine-sparing effects. High-quality studies with more patients are needed in the future.

Keywords

Acetaminophen Pain control Total knee arthroplasty Meta-analysis 

Abbreviations

CI

Confidence interval

IV

Intravenous

NOS

Newcastle-Ottawa Quality Assessment Scale

OA

Osteoarthritis

POD

Postoperative day

RA

Rheumatoid arthritis

RCS

Retrospective cohort studies

RCTs

Randomized controlled trials

RR

Risk ratio

TKA

Total knee arthroplasty

VAS

Visual analogue scale

WMD

Weighted mean difference

Background

Total knee arthroplasty (TKA) is being widely used for end-stage osteoarthritis (OA) or rheumatoid arthritis (RA) [1]. However, over 80% of TKA patients experience severe to moderate postoperative pain [2]. Inadequate pain management may result in dissatisfaction, complications, stunted postoperative functional recovery, and longer hospital stays [3, 4]. Conventionally, multimodal pain management is widely recommended and accepted [5, 6]. Multimodal pain management usually includes two or more analgesics, such as opioids, nonsteroidal anti-inflammatory medications, steroid hormones, and epinephrine [7]. It has been reported that rebounding pain in patients treated with multimodal pain management after 24 h postoperatively remains a real problem for surgeons [8, 9]. Furthermore, the use of opioids is frequently associated with some side effects, including gastrointestinal symptoms, autonomic nervous system symptoms, and central nervous system symptoms, among others [10, 11]. Thus, adjunctive pain management medication is needed.

Recently, combination therapy with intravenous (IV) acetaminophen has been used to reduce postoperative pain, and opioid use across a variety of surgical procedures has also been applied to the TKA [12, 13, 14]. Kelly et al. [15] drew the conclusion that IV acetaminophen did not significantly decrease postoperative opioid use in patients who underwent surgical knee procedures. Studies conducted by Blank et al. [16] and Nwagbologu et al. [17] presented similar conclusions. However, O’Neal et al. [18] reported that neither IV nor oral acetaminophen provided better analgesia in patients undergoing TKA. Similar results were reported by subsequent studies [19]. Thus, conclusions concerning the use of IV acetaminophen in reducing postoperative pain and opioid consumption have been inconsistent. Several studies have reported that IV acetaminophen has a beneficial role in reducing pain intensity and morphine consumption after TKA [19, 20]. However, some other studies suggest that the use of acetaminophen in multimodal pain management does not result in improved safety or reduced opioid utilization in hip or knee arthroplasty [17, 21].

Therefore, it is necessary to investigate whether IV acetaminophen as an adjunctive pain management medication provides better analgesic effects, as well as whether it reduces opioid consumption in patients after TKA. The purpose of the current meta-analysis was to compare results concerning the efficacy of IV acetaminophen for pain control in patients undergoing TKA.

Methods

Search strategy

We manually searched randomized controlled trials (RCTs), retrospective cohort studies (RCSs), and cohort studies through PubMed (1996–June 2018), Embase (1980–June 2018), and the Cochrane Library (CENTRAL, June 2018). We also searched trials from related references and reviews. The key words and MeSH terms were “total knee arthroplasty,” “total knee replacement,” “TKA,” “TKR,” “Arthroplasty, Replacement, Knee” [MeSH], and “acetaminophen.” These key words or MeSH terms were combined using the Boolean operators “AND” or “OR.” The search results are presented in Fig. 1.
Fig. 1

Flow of trials through the meta-analysis

Inclusion criteria

Studies were included in our meta-analysis provided that they satisfied the condition of meeting the PICOS (patients, intervention, comparator, outcomes, and study design) study quality assurance guidelines. Other inclusion criteria included the following: (1) Patients had undergone TKA. (2) The intervention was intravenous acetaminophen. (3) The comparator was non-intravenous administration of acetaminophen or placebo. (4) The outcomes included morphine equivalent consumption at POD 1, total morphine equivalent consumption, VAS score at 24, 48, and 72 h and length of hospital stay.

Data extraction

Two reviewers extracted available data from the included studies independently. Extracted data included first author, publication data, participants, age, gender, body mass index, and study design. The primary outcome of our meta-analysis consisted of morphine equivalent consumption at POD 1, total morphine consumption, and VAS score at 24, 48, and 72 h postoperatively. Secondary outcomes consisted of length of hospital stay. We tried emailing the corresponding authors of the studies that used graphical data or had incomplete data. Any disagreement between the two reviewers was resolved by a third reviewer.

Quality assessment

Quality assessment for RCTs was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently evaluated the risk of bias of the included RCTs based on the following items: random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and other sources of bias. For non-RCTs, we used the Newcastle-Ottawa scale to evaluate the risk of bias [22]. We considered a study to be of high quality for non-RCTs when a study achieved a score on the Newcastle-Ottawa scale of more than six points.

Statistical analysis

Stata 12.0 was applied for our meta-analysis. For continuous outcomes, mean difference (MD) with a 95% confidence interval (CI) was used to weigh the effect intervals. We judged the statistical heterogeneity by the P value derived using the standard chi-square test. Values of I2 > 50% were thought to have significant heterogeneity of the outcomes, and a random-effect model was applied for assessment; for others, such as for extracted data, a fixed-effect model was used. We performed subgroup analysis by omitting studies in turn. Subgroup analysis was done according to the study type, anesthesia, allocation concealment, and dose of acetaminophen.

Results

Search results and general characteristics

A total of 142 relevant studies were identified by our search strategies. After duplicates were removed, there were 96 studies left to review. After reading the title and abstract, 90 studies were excluded. Finally, 6 studies [15, 17, 18, 19, 21, 23] were included in our meta-analysis after full-text reading. Among them, there were 2 RCTs [18, 19] and 4 RCSs [15, 17, 21, 23]. General characteristics of the included RCTs can be seen in Table 1. All of the studies were published in 2014. The ages of the TKA patients ranged from 61 to 75.3 years. Four studies [15, 17, 18, 19] administered acetaminophen at a dose of 1000 mg/day, and one study administered acetaminophen at a dose of 4000 mg/day [21].
Table 1

General characteristic of the included studies

Author

Country

Age (year)

Study

Dose of acetaminophen

Control

Follow-up

Anesthesia

Kelly [15]

America

63.9/65.3

RCS

1000 mg/day

Placebo

NS

NS

Nwagbologu [17]

Mexico

61/63.9

RCS

1000 mg/day

Placebo

3 days

NS

O’Neal [18]

America

68/70

RCT

1000 mg/day

Placebo

NS

SA

Murata-Ooiwa [19]

Japan

73.6/75.3

RCT

1000 mg/day

Placebo

3 days

SA

Ciummo [23]

America

NS

RCS

NS

Placebo

NS

NS

Huang [21]

America

71.3/71.6

RCS

4000 mg/day

Placebo

3 days

SA/GA

RCT randomized controlled trials, RCS retrospective controlled studies, NS not stated, SA spinal anesthesia, GA general anesthesia

Quality assessment of the included studies

The risk of bias summary and the risk of bias graph for the RCTs can be seen in Figs. 2 and 3, respectively. The two RCTs were both determined to be of high quality. The quality assessments of the non-RCTs can be seen in Table 2. Total scores of NOS ranged from 6 to 8.
Fig. 2

Risk of bias summary of the RCTs

Fig. 3

Risk of bias graph of the RCTs

Table 2

Newcastle-Ottawa scale for the non-RCTs

Author

Selection

Comparability

Outcomes

Total score

Kelly [15]

***

**

**

7

Nwagbologu [17]

**

**

**

6

Ciummo [23]

***

**

***

8

Huang [21]

**

**

**

6

* represent 1 score

Meta-analysis results

Total morphine equivalent consumption

Four studies, having a total of 398 patients, reported equivalent total morphine consumptions. Compared with the control group, the IV acetaminophen group was associated with a reduction in total morphine consumption of approximately 11.59 mg (WMD = − 11.59; 95%CI, [− 23.11, − 0.08]; P = 0.048; I2 = 84.1%, Fig. 4).
Fig. 4

Forest plots of the included studies comparing the total morphine equivalent consumption

Morphine equivalent consumption at POD 1

Data from 2 studies, including 264 patients, reported equivalent morphine consumption at POD 1. There were no significant differences between the IV acetaminophen group and control group in terms of morphine consumption at POD 1 (WMD = 3.73; 95%CI, [− 5.82, 13.28]; P = 0.444; I2 = 41.5%, Fig. 5).
Fig. 5

Forest plots of the included studies comparing the morphine equivalent consumption at POD 1

Visual analogue scale at POD 1

The visual analogue scale score at POD 1 was measured in 4 studies, having a total of 216 patients. We did not find any significant difference between the IV acetaminophen and control groups (WMD = − 4.24; 95%CI, [− 20.24, 11.75]; P = 0.603; I2 = 95.2%, Fig. 6).
Fig. 6

Forest plots of the included studies comparing the visual analogue scale score at POD 1

Visual analogue scale at POD 2

The visual analogue scale score at POD 2 was measured in 3 studies, having a total of 216 patients. There was no significant difference between IV acetaminophen and control groups in terms of the VAS score at POD 2 (WMD = − 0.26; 95%CI, [− 0.57, 0.05]; P = 0.105; I2 = 0.0%, Fig. 7).
Fig. 7

Forest plots of the included studies comparing the visual analogue scale score at POD 2

Visual analogue scale at POD 3

The visual analogue scale score at POD 3 was reported in 4 studies, having a total of 331 patients. Compared with the control group, the IV acetaminophen group was associated with a reduction in VAS score at POD 3 (WMD = − 0.34; 95%CI, [− 0.68, − 0.01]; P = 0.045; I2 = 0.0%, Fig. 8).
Fig. 8

Forest plots of the included studies comparing the visual analogue scale score at POD 3

Length of hospital stay

We extracted length of hospital stay data from 4 studies, involving 398 patients. There were no significant differences between the IV acetaminophen and control groups in terms of the length of hospital stay (WMD = − 0.09; 95%CI, [− 0.23, 0.05]; P = 0.226; I2 = 58.1%, Fig. 9).
Fig. 9

Forest plots of the included studies comparing the length of hospital stay

Sensitivity analysis and subgroup analysis

The sensitivity analysis can be seen in Additional file 1: Figure S1. The results showed that after omitting each study in turn, the overall effects were in the upper CI limit and lower CI limit.

Subgroup analysis results can be seen in Table 3. The findings of decreased total morphine consumption were consistent in all subgroup analyses except for the allocation concealment and anesthesia subgroups.
Table 3

Subgroup analysis of the total morphine consumption

Subgroups

No. of studies

Mean difference [95% CI]

P value

I2 (%)

Between subgroup significance

Total morphine consumption

 Allocation concealment

  Adequate

2

 2.39 (− 43.70, 38.92)

0.910

94.5

0.002

  Unclear

2

− 18.62 (− 23.56, − 0.08)

0.000

0

 Study type

  RCT

1

− 19.70 (− 22.35, − 15.43)

0.029

0

0.124

  RCS

3

− 20.45 (− 24.04, − 16.85)

0.038

0

 Acetaminophen dose

  1000 mg/day

3

− 4.42 (− 33.04, 24.20)

0.762

89.4

0.139

  4000 mg/day

1

− 19.00 (− 24.03, − 13.97)

0.000

 

 Anesthesia

  GA

2

− 2.39 (− 43.70, 38.92)

0.910

94.5

0.048

  SA

2

− 18.62 (− 23.56, − 13.68)

0.000

 

GA general anesthesia, SA spinal anesthesia, RCT randomized controlled trials, RCS retrospective controlled studies

Discussion

The current meta-analysis indicated that compared with a control group, intravenous acetaminophen was associated with reductions in total morphine consumption and VAS score at POD 3. There was no significant difference in morphine consumption at POD 1 or in VAS score at POD 1 or 2. Moreover, there was no significant difference in length of hospital stay between the intravenous acetaminophen group and the control group.

Inadequate pain management following TKA may influence the functional recovery, increase opioid consumption, and contribute to several complications [24]. Recently, multimodal pain management has been widely applied in TKA [25]. Multimodal pain management usually includes two or more medications with different mechanisms, such as opioids, nonsteroidal anti-inflammatory medications, steroids, and epinephrine. It is worth noting that the usage of opioids is frequently associated with side effects, such as nausea, vomiting, and pruritus [26]. Moreover, it has been reported that the pain score became worse at 24 h after TKA. The rebounding pain of multimodal pain management after POD 1 remains an important issue in patients who have received TKA [9]. More recently, multimodal pain management with IV acetaminophen for postoperative pain management has generated much discussion [27].

It was reported that opioid consumption was reduced from 29 to 39% in patients who received IV acetaminophen compared to a placebo in orthopedic procedures [28]. IV acetaminophen has been shown to have efficacy for reducing the consumption of opioids [15]. Murata-Ooiwa et al. [19] demonstrated that the VAS score was significantly better in the intravenous acetaminophen group than the placebo group at day 1 after TKA, with no significant differences in terms of the rate of complications between the groups. They drew the conclusion that intravenous acetaminophen provided better pain relief for patients undergoing unilateral TKA.

However, recently, other studies have reported different conclusions [18, 23]. In the O’Neal et al. study [18], the VAS scores of IV acetaminophen and placebo groups were compared, as well as total the morphine consumption, among other parameters. No significant differences were found between all groups for any outcome. Nwagbologu et al. [17] reported that the use of IV acetaminophen was not associated with a decrease in opioid use, opioid-related side effects, or any other outcomes in patients who received TKA. The current meta-analysis indicated that IV acetaminophen was associated with a statistically significant reduction in total morphine consumption by approximately 11.59 mg compared with a control group.

There was significantly heterogeneity between the included studies (I2 = 84.1%). Despite performing sensitivity analysis to diminish the impact of heterogeneity, the effect of heterogeneity still could not be eliminated completely. In the sensitivity analysis, we found that the study of Nwagbologu et al. [17] was the source of this heterogeneity. Nwagbologu et al. [17] recorded that the IV acetaminophen group and placebo group received similar doses of total morphine equivalents at 24 and 48 h postoperatively. We analyze the reason as follows: (1) this was a retrospective cohort study and may have had a selection bias; (2) this study comprised two doses of acetaminophen (1000 mg/day and 2000 mg/day), so opioid-sparing effects may be related to the amount of IV acetaminophen received; (3) this study simply added onto other pain medication orders without any organized or concerted effort to use a multimodal pain regimen to reduce opioid consumption.

VAS score was also an important result in our meta-analysis. Current meta-analysis indicated that IV acetaminophen only has a beneficial role in reducing VAS score at POD 3. Murata-Ooiwa et al... [19] reported that the VAS score at 17:00 1 day after TKA was significantly better in the intravenous acetaminophen group than the placebo group. In contrast, some published studies have recently reported that IV acetaminophen has no effects on pain relief [18]. O’Neal et al. [18] reported that no significant differences were found between the IV acetaminophen and placebo groups regarding the VAS score. Similarly, Ciummo et al. [23] declared that there was no statistically significant difference in average daily postoperative VAS score.

Similar findings were reported by Murata-Ooiwa et al. [19]. In Murata-Ooiwa et al.’s study [19], there were no significant differences in the rate of complications. With regard to LOS, Ciummo et al. [23] reported that no significant differences were found. Kelly et al. [15] reported that the median length of LOS for both the IV acetaminophen and placebo groups was 3 days. In the Nwagbologu et al. study [17], the LOS in IV acetaminophen and control groups were 3.7 days and 3.9 days, respectively. These results were consistent with our meta-analysis. Therefore, we concluded that IV acetaminophen was not associated with a reduction in the length of hospital stay in patients who received TKA.

Our meta-analysis has several limitations: (1) Only six studies were included in our meta-analysis. The statistical efficacy of our results would be more reliable if more studies had been included. (2) Only English publications were included in our meta-analysis; therefore, publication bias was unavoidable. (3) Outcomes such as range of motion of the knee and knee society score were not analyzed due to insufficient data. (4) Follow-ups of these studies were relatively short, and long-term follow-ups are needed to identify the knee function between these two groups. (5) There was substantial heterogeneity between included outcomes. We performed subgroup analysis and sensitivity analysis to decrease the heterogeneity; however, the overall heterogeneity was not changed after subgroup analysis or after sensitivity analysis. Thus, the results of this meta-analysis should be carefully interpreted.

Conclusion

In conclusion, based on our results, IV acetaminophen in multimodal management has shown better efficacy than a control for pain relief at POD 3 and has morphine-sparing effects. We identified six studies; in the future, the multimodal pain management protocol after TKA may change when more studies are published and included in the meta-analysis. Due to the limited studies and participants, further high-quality studies with more patients are needed to validate the optimal dose of IV-acetaminophen.

Notes

Funding

There is no funding for this article.

Availability of data and materials

We state that the data will not be shared since all of the raw data are present in the figures included in the article.

Consent for publication

Not applicable.

Authors’ contributions

SBS and XBW conceived the study design. JMS performed the study, collected the data, and contributed to the study design. SFG and ZXC prepared the manuscript. YW edited the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

None

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary material

13018_2018_950_MOESM1_ESM.tif (861 kb)
Additional file 1: Figure S1. Sensitivity analysis of the total morphine equivalent consumption (A), morphine equivalent consumption at POD 1 (B), visual analogue scale score at POD 1 (C), visual analogue scale score at POD 2 (D), visual analogue scale score at POD 3 (E), and length of hospital stay (F). (TIF 860 kb)

References

  1. 1.
    Sun X, Su Z. A meta-analysis of unicompartmental knee arthroplasty revised to total knee arthroplasty versus primary total knee arthroplasty. J Orthop Surg Res. 2018;13(1):158.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Dong P, Tang X, Cheng R, Wang J. Comparison of the efficacy of different analgesia treatments for total knee arthroplasty: a network meta-analysis. Clin J Pain. 2018;34(11):1047–60.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Li C, Qu J, Pan S, Qu Y. Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2018;13(1):112.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplast. 2018;33(1):90–6.CrossRefGoogle Scholar
  5. 5.
    Suarez JC, Al-Mansoori AA, Kanwar S, Semien GA, Villa JM, McNamara CA, Patel PD. Effectiveness of novel adjuncts in pain management following total knee arthroplasty: a randomized clinical trial. J Arthroplast. 2018;33(7s):S136–s141.CrossRefGoogle Scholar
  6. 6.
    Gaffney CJ, Pelt CE, Gililland JM, Peters CL. Perioperative pain management in hip and knee arthroplasty. Orthop clin North Am. 2017;48(4):407–19.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Brooks E, Freter SH, Bowles SK, Amirault D. Multimodal pain management in older elective arthroplasty patients. Geriatric orthop surg rehabilitation. 2017;8(3):151–4.CrossRefGoogle Scholar
  8. 8.
    Tsukada S, Wakui M, Hoshino A. Postoperative epidural analgesia compared with intraoperative periarticular injection for pain control following total knee arthroplasty under spinal anesthesia: a randomized controlled trial. J Bone Joint Surg Am. 2014;96(17):1433–8.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Tsukada S, Wakui M, Hoshino A. The impact of including corticosteroid in a periarticular injection for pain control after total knee arthroplasty: a double-blind randomised controlled trial. bone joint j. 2016;98-b(2):194–200.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Dahl JB, Rosenberg J, Dirkes WE, Mogensen T, Kehlet H. Prevention of postoperative pain by balanced analgesia. Br J Anaesth. 1990;64(4):518–20.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Cancienne JM, Patel KJ, Browne JA, Werner BC. Narcotic use and total knee arthroplasty. J Arthroplast. 2018;33(1):113–8.CrossRefGoogle Scholar
  12. 12.
    Saurabh S, Smith JK, Pedersen M, Jose P, Nau P, Samuel I. Scheduled intravenous acetaminophen reduces postoperative narcotic analgesic demand and requirement after laparoscopic roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(2):424–30.CrossRefGoogle Scholar
  13. 13.
    Mont MA, Lovelace B, Pham AT, Hansen RN, Chughtai M, Gwam CU, Khlopas A, Barrington JW. Intravenous acetaminophen may be associated with reduced odds of 30-day readmission after total knee arthroplasty. j knee surg. 2018.Google Scholar
  14. 14.
    Subramanyam R, Varughese A, Kurth CD, Eckman MH. Cost-effectiveness of intravenous acetaminophen for pediatric tonsillectomy. Paediatr Anaesth. 2014;24(5):467–75.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Kelly JS, Opsha Y, Costello J, Schiller D, Hola ET. Opioid use in knee arthroplasty after receiving intravenous acetaminophen. Pharmacotherapy. 2014;34(Suppl 1):22s–6s.CrossRefGoogle Scholar
  16. 16.
    Blank JJ, Berger NG, Dux JP, Ali F, Ludwig KA, Peterson CY. The impact of intravenous acetaminophen on pain after abdominal surgery: a meta-analysis. J Surg Res. 2018;227:234–45.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Nwagbologu N, Sarangarm P, D'Angio R. Effect of intravenous acetaminophen on postoperative opioid consumption in adult orthopedic surgery patients. Hosp Pharm. 2016;51(9):730–7.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    O'Neal JB, Freiberg AA, Yelle MD, Jiang Y, Zhang C, Gu Y, Kong X, Jian W, O'Neal WT, Wang J. Intravenous vs oral acetaminophen as an adjunct to multimodal analgesia after total knee arthroplasty: a prospective, randomized, double-blind clinical trial. J Arthroplast. 2017;32(10):3029–33.CrossRefGoogle Scholar
  19. 19.
    Murata-Ooiwa M, Tsukada S, Wakui M. Intravenous acetaminophen in multimodal pain management for patients undergoing total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Arthroplast. 2017;32(10):3024–8.CrossRefGoogle Scholar
  20. 20.
    Apfel C, Jahr JR, Kelly CL, Ang RY, Oderda GM. Effect of i.v. acetaminophen on total hip or knee replacement surgery: a case-matched evaluation of a national patient database. Am J Health Syst Pharm. 2015;72(22):1961–8.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Huang PS, Gleason SM, Shah JA, Buros AF, Hoffman DA. Efficacy of intravenous acetaminophen for postoperative analgesia in primary total knee arthroplasty. J Arthroplast. 2018;33(4):1052–6.CrossRefGoogle Scholar
  22. 22.
    Hartling L, Ospina M, Liang Y, Dryden DM, Hooton N, Krebs Seida J, Klassen TP. Risk of bias versus quality assessment of randomised controlled trials: cross sectional study. BMJ (Clinical research ed). 2009;339:b4012.CrossRefGoogle Scholar
  23. 23.
    Ciummo F, Cheon E, Samide J, Habib H, Abraham T, Tischler H. 1570: multimodal pain management in total knee replacement with or without intravenous acetaminophen. Crit Care Med. 2016;44(12):468.CrossRefGoogle Scholar
  24. 24.
    Laoruengthana A, Rattanaprichavej P, Rasamimongkol S, Galassi M. Anterior vs posterior periarticular multimodal drug injections: a randomized, controlled trial in simultaneous bilateral total knee arthroplasty. J Arthroplast. 2017;32(7):2100–4.CrossRefGoogle Scholar
  25. 25.
    Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93(11):1075–84.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Jiang J, Teng Y, Fan Z, Khan MS, Cui Z, Xia Y. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplast. 2013;28(10):1882–7.CrossRefGoogle Scholar
  27. 27.
    Politi JR, Davis RL 2nd, Matrka AK. Randomized prospective trial comparing the use of intravenous versus oral acetaminophen in total joint arthroplasty. J Arthroplast. 2017;32(4):1125–7.CrossRefGoogle Scholar
  28. 28.
    Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102(4):822–31.CrossRefPubMedCentralGoogle Scholar

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Song-bo Shi
    • 1
  • Xing-bo Wang
    • 1
  • Jian-min Song
    • 1
  • Shi-fang Guo
    • 1
  • Zhi-xin Chen
    • 1
  • Yin Wang
    • 1
  1. 1.Orthopaedics DepartmentGansu Provincial HospitalLanzhouChina

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