{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:57Z","timestamp":1787017077461,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,3,7]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>As ambulatory spine surgery increases, efficient recovery and discharge become essential. Multimodal analgesia is superior to opioids alone. Acetaminophen is a central component of multimodal protocols and both intravenous and oral forms are used. While some advantages for intravenous acetaminophen have been touted, prospective studies with patient-centered outcomes are lacking in ambulatory spine surgery. A substantial cost difference exists. We hypothesized that intravenous acetaminophen would be associated with fewer opioids and better recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients undergoing ambulatory spine surgery were randomized to preoperative oral placebo and intraoperative intravenous acetaminophen or preoperative oral acetaminophen. All patients received general anesthesia and multimodal analgesia. The primary outcome was 24-hour opioid use in intravenous morphine milligram equivalents (MMEs), beginning with arrival to the postanesthesia care unit (PACU). Secondary outcomes included pain, Quality of Recovery (QoR)-15 scores, postoperative nausea and vomiting, recovery time, and correlations between pain catastrophizing, QoR-15, and pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 82\u2009patients were included in final analyses. Demographics were similar between groups. For the primary outcome, the median 24-hour MMEs did not differ between groups (12.6 (4.0, 27.1) vs 12.0 (4.0, 29.5) mg, p=0.893). Postoperative pain ratings, PACU MMEs, QoR-15 scores, and recovery time showed no differences. Spearman\u2019s correlation showed a moderate negative correlation between postoperative opioid use and QoR-15.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intravenous acetaminophen was not superior to the oral form in ambulatory spine surgery patients. This does not support routine use of the more expensive intravenous form to improve recovery and accelerate discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04574778\">NCT04574778<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2024-105386","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T13:55:28Z","timestamp":1710770128000},"page":"483-488","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Intravenous versus oral acetaminophen for pain and quality of recovery after ambulatory spine surgery: a randomized controlled trial"],"prefix":"10.1136","volume":"50","clinical-trial-number":[{"clinical-trial-number":"nct04574778","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04574778","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3464-4149","authenticated-orcid":false,"given":"Eric S","family":"Schwenk","sequence":"first","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polina","family":"Ferd","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc C","family":"Torjman","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J","family":"Li","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R","family":"Charlton","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian Z","family":"Yan","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"McCurdy","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Rothman Orthopaedics, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K","family":"Kepler","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Rothman Orthopaedics, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Rothman Orthopaedics, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew N","family":"Fleischman","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Issa","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Rothman Orthopaedics, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"2025101111160126000_50.6.483.1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004380"},{"key":"2025101111160126000_50.6.483.2","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1016\/j.spinee.2023.09.005","article-title":"Unplanned Readmissions following ambulatory spine surgery: assessing common reasons and risk factors","volume":"23","author":"Amen","year":"2023","journal-title":"Spine J"},{"key":"2025101111160126000_50.6.483.3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.wneu.2022.03.098","article-title":"Perioperative multimodal analgesia for adults undergoing surgery of the spine-a systematic review and meta-analysis of three or more modalities","volume":"163","author":"Licina","year":"2022","journal-title":"World 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of the pain sensitivity questionnaire and the pain catastrophizing scale in predicting postoperative pain and pain chronicization after spine surgery","volume":"31","author":"Tuna","year":"2018","journal-title":"Clin Spine Surg"},{"key":"2025101111160126000_50.6.483.13","doi-asserted-by":"crossref","unstructured":"Sinatra RS . Oral and parenteral opioid Analgesics for acute pain management. In: Sinatra RS , de Leon-Casasola OA , Ginsberg B , et al , eds. Acute pain management. New York, NY: Cambridge University Press, 2009.","DOI":"10.1017\/CBO9780511576706.015"},{"key":"2025101111160126000_50.6.483.14","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jss.2017.12.040","article-title":"Severity classification of the quality of recovery-15 score-an observational study","volume":"225","author":"Kleif","year":"2018","journal-title":"J Surg Res"},{"key":"2025101111160126000_50.6.483.15","doi-asserted-by":"crossref","first-page":"E1429","DOI":"10.1097\/BRS.0000000000002180","article-title":"Trend of spine surgeries in the outpatient hospital setting versus ambulatory surgical center","volume":"42","author":"Idowu","year":"2017","journal-title":"Spine"},{"key":"2025101111160126000_50.6.483.16","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/j.1526-4637.2011.01141.x","article-title":"Perioperative intravenous acetaminophen and NSAIDs","volume":"12","author":"Smith","year":"2011","journal-title":"Pain Med"},{"key":"2025101111160126000_50.6.483.17","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s12630-022-02257-6","article-title":"Effect of intravenous acetaminophen on postoperative outcomes in hip fracture patients: a systematic review and narrative synthesis","volume":"69","author":"Cho","year":"2022","journal-title":"Can J Anaesth"},{"key":"2025101111160126000_50.6.483.18","article-title":"Unlocking the optimal analgesic potential: a systematic review and meta-analysis comparing intravenous, oral, and rectal paracetamol in equivalent doses","volume":"15","author":"Ibrahim","year":"2023","journal-title":"Cureus"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2024-105386","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:16:11Z","timestamp":1760206571000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2024-105386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,18]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,10]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/rapm-2024-105386"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2024-105386","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,18]]}}}