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J Clin Med Res. 2018 Jun;10(6):499-507. doi: 10.14740/jocmr3380w. Epub 2018 Apr 13.

Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies.

Author information

Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA.
School of Pharmacy, University of California San Francisco, San Francisco, CA, USA. This author was an employee of Mallinckrodt Pharmaceuticals during the conduct of this study.
Boston Strategic Partners, Inc., Boston, MA, USA.
Medical Affairs Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA.
OptiStatim, LLC, Longmeadow, MA, USA.



Post-surgical pain impacts many patient outcomes. Effective pain management increasingly relies on multimodal analgesia regimens in which acetaminophen (APAP) is a key component. The aim of our study was to examine the impact of oral APAP versus intravenous (IV) APAP as a component of post-surgical pain management after Cesarean sections and hysterectomies.


A retrospective analysis of the Cerner HealthFacts® database (from January, 2011 to December, 2015) was conducted to compare outcomes of Cesarean section and hysterectomy surgery patients who received oral APAP to those who received IV APAP post-surgically. Length of stay (LOS), daily morphine milligram equivalent (MME) consumption, the presence of potential opioid-related adverse events (ORADEs), and total pharmacy costs were assessed. Adjusted results were derived using inverse probability weighted regression adjustment (IPW-RA) estimators based on covariates that included demographics, comorbidities, patient clinical characteristics, and hospital characteristics.


The study identified 29,124 Cesarean section patients (24,612 oral APAP; 4,512 IV APAP) and 9,767 hysterectomy surgery patients (5,586 oral APAP; 4,181 IV APAP). Compared to the oral APAP group, the IV APAP group had reductions in adjusted LOS (Cesarean section: -11.7% days (P < 0.001), hysterectomy: -11.8% days (P = 0.005)), lowered adjusted daily MME consumption from day 0 to day 3 (Cesarean section: -1.6 mg (P < 0.001), hysterectomy: -1.7 mg (P = 0.014)), and reduced risk of ORADEs for Cesarean sections (relative risk of 0.45, P < 0.001). Total pharmacy costs were not significantly different between the two APAP groups.


Post-surgical pain managed with IV APAP in patients undergoing Cesarean section or hysterectomy was associated with shorter LOS, reduced risk of ORADEs, and lower opioid consumption compared to patients managed with oral APAP, without adversely impacting total pharmacy costs.


Acute pain; Cesarean section; Health outcomes; Hysterectomy; IV acetaminophen; Multimodal analgesia; Opioid; Post-surgical pain

Conflict of interest statement

EAB, RF, GJW, and JC are employees of Mallinckrodt Pharmaceuticals, and BL and ATP were employees of Mallinckrodt Pharmaceuticals at the time of the study. VK and XZ are consultants with Boston Strategic Partners, Inc., which contracted with Mallinckrodt Pharmaceuticals for this study. BHN is an employee of OptiStatim, LLC and was contracted for this study by Boston Strategic Partners, Inc.

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