1. The Effects of Intravenous Acetaminophen Use on Robot-Assisted Pelvic Surgery Patients Nichole Witmyer, Pharm.D. St. Dominic Hospital Jackson, Mississippi BACKGROUND PURPOSE RESULTS The primary objectives are to determine if the use of intravenous acetaminophen, in combination with other analgesic agents, can decrease length of stay and the need for scheduled and as-needed opioids postoperative compared to a set of control patients. Secondary objectives include examining the total amount of acetaminophen used within a twenty-four hour time period and any adverse events reported. Acetaminophen has been used to treat mild to moderate pain for years in its oral and rectal forms. In 2010, when intravenous acetaminophen (APAP IV) was approved, it provided an option for hospitalized patients unable to take previous dosage forms. It also provided an option specifically for surgical patients who experience predictable, but sometimes difficult to treat, postoperative pain. It has been proposed that beginning APAP IV either in the perioperative or postoperative setting can reduce postoperative pain, the chance of postoperative ileus, and overall opioid administered. This study will look at the effect of intravenous acetaminophen as a part of multimodal pain management, overall opioid use, and length of stay. Mean length of stay for control patients was 1.47 days (0.2-7.3) versus 1.68 days (0.2-10.1) for APAP IV patients (P=0.710). Mean ME administered to control patients was 24 (0-192.7) versus 28 (0-135.97) for APAP IV patients (P=0.191). 35 patients (71%) patients in the APAP IV group received only one dose in the perioperative setting and no doses postoperative. 12 (24%) patients in the APAP IV group received ≥ 3 grams of APAP in the first 24 hours 5 (10%) patients in the APAP IV group received > 4 grams of APAP in the first 24 hours The secondary objective of reported adverse events is still under investigation. 27 (55%) patients in the control group versus 18 (37%) patients in the APAP IV group were administered ketorolac IV (mean dose 79mg versus 86mg), however was not considered in the ME analysis since there is no definitive morphine equianalgesic dose. CONCLUSIONS METHODS This is a retrospective chart review of patients from July 1, 2014 to November 30, 2014 with ICD-9/ICD-10 codes for robot-assisted pelvic surgeries. Perioperative anesthesia records and medication administration records were used to record the number of doses of intravenous acetaminophen and postoperative analgesia doses. Postoperative opioid analgesia doses will be converted to morphine equivalence (ME) for comparison. Due to normality test failing, a student t-test could not be used in evaluating length of stay or opioid use. A Mann-Whitney Rank Sum Test was used to determine any difference. Only analgesics with known morphine equianalgesic dosing were used to calculate total opioid doses administered The use of APAP IV did not show any statistical significance in patient length of stay or overall opioid use for robot-assisted pelvic surgery patients. The difference in the median values between the two groups for LOS and opioid use is not great enough to exclude the possibility that the difference is due to random sampling variability. More patients in the control group received a nonsteroidal anti- inflammatory agent than the APAP group and may have reduced the need for postoperative opioid use. 71% of APAP IV patients received only one dose of APAP IV during surgery which may have been insufficient to decease postoperative pain. This medication use evaluation is expected to continue to obtain an equal amount of patients based on admission status to reduce length of stay result variability and to evaluate any adverse events especially in patients receiving over the FDA recommended amount of APAP in a 24 hour period. Disclosure: Author of this presentation has nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation No APAP APAP