IV Acetaminophen for Postoperative Pain Analgesia After Laparoscopic Hysterectomy
IV Acetaminophen for Postoperative Pain Analgesia After Laparoscopic Hysterectomy
The objective of this study is to quantify the change in post-operative pain scores and
 narcotic requirements in women receiving pre and post-operative IV acetaminophen compared to
 placebo in women undergoing laparoscopic hysterectomy.
Gynecologic surgery has been revolutionized by the incorporation of minimally invasive
 techniques. Procedures that once resulted in multiple day hospital admissions are now being
 performed in outpatient surgery centers. Common factors that contribute to delayed discharge
 are inadequate postoperative pain control and increased nausea and vomiting. A multi-modal
 pain management approach is considered optimal at controlling postsurgical pain, which
 includes combining different analgesics that act in varying mechanisms. By using medications
 that act synergistically, the overall analgesia requirement can oftentimes be decreased.

 Opioids have been found to be highly effective in controlling postoperative pain; however,
 are associated with dose-dependent risks including nausea, vomiting, constipation, urinary
 retention, sedation, and respiratory depression. Subsequently, non-opioid options are
 frequently desired in an attempt to minimize narcotic intake. In the United States,
 intravenous acetaminophen was approved by the US Food and Drug Administration (FDA) in
 November 2010 for the management of mild to moderate pain and the reduction of fever. Since
 this time, multiple studies have analyzed the role of intravenous acetaminophen in both acute
 and postoperative pain; however, none have been specific to laparoscopic hysterectomy. The
 primary study published evaluating intravenous acetaminophen in laparoscopic hysterectomies
 also included multiple other laparoscopic procedures from a variety of specialties including
 general surgery, urology, and urogynecology. In addition, the intravenous acetaminophen was
 started on average 19 hours after the conclusion of the case once the patient controlled
 analgesic was discontinued.

 Improved postsurgical pain control achieved with intravenous acetaminophen may potentially
 lead to same day discharge after major laparoscopic gynecologic procedures. Same day
 discharge after laparoscopic hysterectomy has been shown to be a safe option with proper
 patient counseling and multi-modal pain medications. In addition, same day discharge is also
 associated with decreased health care expenditures. With continued efforts to cut hospital
 costs, the pressure to discharge patients earlier continues to be high.

 The investigators propose that intravenous acetaminophen will improve post-operative pain
 control and decrease narcotic requirements for patients undergoing laparoscopic
 hysterectomies. Furthermore, The investigators expect to find decreased postsurgical nausea
 and vomiting and potentially quicker discharge to home. This could have a large impact on the
 field of gynecologic surgery as major procedures that once required overnight admission may
 now succeed at same day discharge.
Inclusion Criteria:

 -  Women aged 18-75

 -  Ability to read and write in English (our post-operative pain log is only available in
 English)

 -  Planning a laparoscopic hysterectomy (includes total laparoscopic hysterectomy,
 laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal
 hysterectomy, with or without salpingooophorectomy)

 Exclusion Criteria:

 -  Answering yes to any of the following questions: "Do you have a history of liver
 disease, kidney disease, hepatitis C, history of liver failure, greater than 3 drinks
 per day or being have you ever been told by your doctor that they should not take
 acetaminophen"

 -  History of cardiac arrhythmia

 -  History of jaundice

 -  Acute abdominal inflammatory or infectious process at time of surgery

 -  Known malignancy at time of surgery

 -  Known pregnancy at time of surgery

 -  Plan to perform additional significant surgical procedure at the time of hysterectomy
 such as extensive excision of endometriosis on bowel or bladder or pelvic
 reconstructive procedure

 -  >6cm abdominal incision in order to remove the uterus at time of study-related
 hysterectomy

 -  Regular use of narcotic pain medication (defined as use on most days of the week at
 any point in the past 3 months)

 -  Allergy to acetaminophen

 -  Women who weigh less than 50 kilograms on the day of surgery.