The Role of Intravenous Acetaminophen in Multimodal Pain Protocols for Perioperative Orthopedic Patients

Neurosurgeon, Orthopaedic Trauma, Surgeon, The anesthesiologist and specialist on medical emergency conditions

Multimodal pain management should be considered for all perioperative orthopedic patients. The goal of reducing the amount of perioperative opioid medication given may be achieved by using nonopioid medications, including intravenous acetaminophen. The site of action of acetaminophen is a variety of receptors in the central nervous system.

When given intravenously, acetaminophen produces a much higher plasma concentration, which then leads to higher levels in the cerebrospinal fluid. The safety profile and relative lack of systemic adverse reactions make this an attractive analgesic for a wide variety of orthopedic surgical patients. Clinical studies have demonstrated the efficacy and safety of intravenous acetaminophen in elective total hip and knee arthroplasty, knee arthroscopy, lumbar spine surgery, and for acute traumatic limb pain.

Dr Lachiewicz is from Chapel Hill Orthopedics Surgery and Sports Medicine; the Department of Orthopaedic Surgery, Duke University; and Durham VA Medical Center, Chapel Hill, North Carolina.

Dr Lachiewicz is a consultant for Allergan, Cadence, GSK, Gerson Lehrman Group, and Guidepoint Global Advisors, and his practice receives research funding from Zimmer. Dr Lachiewicz was compensated by SLACK Incorporated for his contribution to this supplement.

 Correspondence should be addressed to: Paul F. Lachiewicz, MD, 101 Conner Dr, Ste 200, Chapel Hill, NC 27514 (

28 April, 2017

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