Jeff Gadsden, MD
Associate Professor
Duke University School of Medicine
Chief, Division of Orthopaedic, Plastic and Regional Anesthesiology
Duke University Medical Center
Chapel Hill, North Carolina
Associate Professor
Duke University School of Medicine
Chief, Division of Orthopaedic, Plastic and Regional Anesthesiology
Duke University Medical Center
Chapel Hill, North Carolina
Related Videos
What did the TKR orthopedic study by Sinatra and colleagues show about the pain relieving properties of IV acetaminophen (four doses) and its effect on rescue opioid use and reduction of total morphine usage?
What are the effects of IV opioids on gastric emptying, transit, and GI absorption of IV acetaminophen versus oral acetaminophen? What is the clinical and PK impact of giving concomitant opioids on these two routes of acetaminophen administration?
Since a significant effect of acetaminophen is on central CNS receptors, what do studies measuring CSF levels show regarding IV administration of acetaminophen? What do AUC results show and what is the significance of these findings clinically?
What do T-max-focused studies show about the advantages of the IV route of administration of acetaminophen over oral and other formulations?
What are the implications of IV acetaminophen having 100% bioavailability versus the oral formulation which undergoes first pass hepatic metabolism? How does this affect C-max and what are the clinical implications?
If you have a surgical patient who is on both IV acetaminophen and an IV opioid and the patient becomes intolerant to the opioid, can you continue the IV acetaminophen alone as monotherapy and/or what other non-opioid might you add to achieve synergies?
Can you compare and contrast the efficacy and, especially, the safety of IV acetaminophen with the other IV non-opioid agents that are sometimes used in conjunction with IV opioids? Why do you consider acetaminophen the “backbone” of multimodal analgesia?
In what specific surgical procedures — from orthopedics to colorectal surgery — is IV acetaminophen indicated as a core agent in the context of multimodal management and ERAS? And what are the indications for this agent?
What is the exact dosing schedule you recommend and use for acetaminophen? Why do you feel that IV acetaminophen is preferable to the oral formulation and what is the effect of IV opioids on absorption and blood levels or oral acetaminophen? ...