Eugene R. Viscusi, MD
Associate Professor
Director, Acute Pain Management Service
Department of Anesthesiology
Thomas Jefferson University
Philadelphia, Pennsylvania
What are the ASA/APS guideline recommendations for multimodal perioperative pain management and how important are opioids as drivers to prolongation of LOS associated with surgical procedures?
What is the evidence that opioid-related side effects compromise patient-related outcomes and satisfaction? And prolong LOS?
What is the optimal dosing schedule for IV acetaminophen and how should it be combined with opioid therapy?
Are there any situations where you might consider the use of IV acetaminophen as part of monotherapy for certain surgical procedures, as opposed to its use as a non-opioid foundational agent that is part of a multimodal approach requiring rescue with opioids?
What are the mechanism(s) of action by which IV acetaminophen exerts its pain-relieving properties and how is this differentiated from other agents?
How does the MOA of IV acetaminophen suggest how to combine it with other agents as part of multimodal management for ERAS?
Is there a patient preference component that is a significant driver to helping select agents for multimodal therapy? And what about expectations as part of the ERAS pathway?
Do we have studies that provide information about the comparative efficacy of non-opioid agents used as part of multimodal perioperative pain management? And what about comparative safety?
From a safety and efficacy standpoint, what is the rationale for using such agents as IV acetaminophen as part of multimodal analgesia to reduce overall opioid consumption?
Can you walk us through the practical and “best practice” aspects and roadmap for how to dose and infuse IV acetaminophen, including timing and duration of administration as part of an ERAS protocol?
What is the clinical importance of avoiding the hepatic first-pass effect when using the IV versus oral formulation of acetaminophen, and what PK advantages and tissue penetration/compartment effects are observed that are responsible for improved efficacy?
Can you summarize the literature- and trial-based support for the use of IV acetaminophen as part of multimodal pain management in the surgical setting?
Is the efficacy of IV acetaminophen “universal” across many types of surgical procedures?
Is the efficacy of IV acetaminophen “universal” across many types of surgical procedures?
What trial-based evidence do you think is most compelling to support the use of IV acetaminophen in the setting of TKR and THR — a high pain model in orthopedic surgery context? Can you summarize the data? What did we learn about the degree ...
Is there a risk of acetaminophen masking a surgical infection because of its anti-pyretic effect?
Is there a risk of acetaminophen masking a surgical infection because of its anti-pyretic effect?
What makes the side effect profile of IV acetaminophen uniquely suited for perioperative pain management as compared to IV opioids?
What are the contraindications to the use of IV acetaminophen?
What are the contraindications to the use of IV acetaminophen?
What other agents or perioperative physiological factors can affect absorption of oral acetaminophen, thereby making this route potentially problematic and less reliable than IV acetaminophen?
What is your strategy in a patient who has become intolerant of an opioid?
What is your strategy in a patient who has become intolerant of an opioid?
How rapid is the onset of action for IV acetaminophen and when is the C-Max achieved after a 15-minute infusion? How does the IV formulation C-Max metrics compare to the oral formulation?
What do we know about patient satisfaction as it relates to perioperative pain management, including in patients on IV acetaminophen? And what role does opioid reduction play?
What is the importance of opioid avoidance as a foundational strategy for multimodal pain management in the perioperative setting? And where does IV acetaminophen fit into that best pain management practice equation?