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Preventive Acetaminophen Reduces Postoperative Opioid Consumption, Vomiting, and Pain Scores After Surgery: Systematic Review and Meta-Analysis

Doleman, Brett MBBS; Read, David BMBS; Lund, Jonathan N. DM; Williams, John P. PhD

Regional Anesthesia and Pain Medicine: November/December 2015 - Volume 40 - Issue 6 - p 706–712
doi: 10.1097/AAP.0000000000000311
Review Articles

Background and Objectives Preventive analgesia has been proposed as a potential strategy to reduce postoperative pain. However, there is currently no review that focuses on acetaminophen for preventive analgesia.

Methods We conducted a search of MEDLINE, EMBASE, Cinahl, AMED, and CENTRAL databases identifying randomized controlled trials that compared preventive acetaminophen with postincision acetaminophen.

Results Seven studies with 544 participants were included. Overall, the studies showed a reduction in 24-hour opioid consumption (standardized mean difference [SMD] of −0.52; 95% confidence interval [95% CI], −0.98 to −0.06), lower pain scores at 1 hour (MD, −0.50; 95% CI, −0.98 to −0.02) and 2 hours (MD, −0.34; 95% CI, −0.67 to −0.01), and a lower incidence of postoperative vomiting (risk ratio, 0.50; 95% CI, 0.31–0.83) in the preventive acetaminophen group. Current studies are limited by a potential risk of bias.

Conclusions To our knowledge, this is the first review to describe a potential preventive effect of acetaminophen. However, well-conducted randomized controlled trials are necessary to substantiate the conclusions of this review.

From the Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, United Kingdom.

Accepted for publication July 9, 2015.

Address correspondence to: Brett Doleman, MBBS, University of Nottingham, Royal Derby Hospital, Uttoxeter Rd, Derby DE22 3DT, United Kingdom (e-mail:

The authors declare no conflict of interest.

This work was presented in part at the GAT conference of The Association of Anaesthetists of Great Britain and Ireland (June 17–19, 2015).

Copyright © 2015 by American Society of Regional Anesthesia and Pain Medicine.