Intravenous acetaminophen for postoperative supratentorial craniotomy pain: a prospective, randomized, double-blinded, placebo-controlled trial

Restricted access

In Brief

The authors designed a randomized, double-blinded, placebo-controlled trial to evaluate intravenous acetaminophen as a scheduled adjunct with our standardized craniotomy pain control regimen. No statistically significant effect was found in narcotic consumption at 24 or 48 hours after surgery. At 24 but not 48 hours, patients treated with intravenous acetaminophen did report significantly lower pain scores than patients given the placebo. These data provide only modest support for using intravenous acetaminophen to improve postoperative craniotomy pain.

ABBREVIATIONS IV = intravenous; NCC = neurocritical care; VAS = visual analog scale.

Article Information

Correspondence Paul A. House: University of Utah, Salt Lake City, UT.

INCLUDE WHEN CITING Published online April 20, 2018; DOI: 10.3171/2017.10.JNS171464.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    IV acetaminophen trial timeline. pts = patients.

  • View in gallery

    CONSORT flow diagram of trial enrollment.

  • View in gallery

    Patient-reported pain scores over time. At 24 hours, the difference in patient-reported pain scores between the two groups was significant (p < 0.001). The difference was no longer significant at 48 hours.



Bijur PESilver WGallagher EJ: Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8:115311572001


Botting RM: Mechanism of action of acetaminophen: is there a cyclooxygenase 3? Clin Infect Dis 31 (Suppl 5):S202S2102000


de Gray LCMatta BF: Acute and chronic pain following craniotomy: a review. Anaesthesia 60:6937042005


Hassouneh BCentofanti JEReddy K: Pain management in post-craniotomy patients: a survey of Canadian neurosurgeons. Can J Neurol Sci 38:4564602011


Hoefnagel ALopez MMitchell KSmith DFeng CNadler J: Intravenous acetaminophen administration in patients undergoing craniotomy - a retrospective institutional study. J Anesth Clin Res 6:92015


Kotak DCheserem BSolth A: A survey of post-craniotomy analgesia in British neurosurgical centres: time for perceptions and prescribing to change? Br J Neurosurg 23:5385422009


Memis DInal MTKavalci GSezer ASut N: Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. J Crit Care 25:4584622010


Molnár CSimon ÉKazup ÁGál JMolnár LNovák L: A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: a single center, randomized, blinded trial. J Neurol Sci 353:70732015


Nemergut ECDurieux MEMissaghi NBHimmelseher S: Pain management after craniotomy. Best Pract Res Clin Anaesthesiol 21:5575732007


Peng KJin XHLiu SLJi FH: Effect of intraoperative dexmedetomidine on post-craniotomy pain. Clin Ther 37:11141121 1121.e12015


Raffa RBFriderichs EReimann WShank RPCodd EEVaught JL: Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an ‘atypical’ opioid analgesic. J Pharmacol Exp Ther 260:2752851992


Remy CMarret EBonnet F: Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth 94:5055132005


Roberts G: A review of the efficacy and safety of opioid analgesics post-craniotomy. Nurs Crit Care 9:2772832004


Shimony NAmit UMinz BGrossman RDany MAGonen L: Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg 125:151315222016


Sivakumar WHouse PHoesch RMartinez JDuncan NAnsari S: Intravenous acetaminophen for postoperative supratentorial craniotomy pain-a randomized, double-blinded, placebo-controlled trial. J Neurosurg 122:A15672015 (Abstract)


Titsworth WLAbram JGuin PHerman MAWest JDavis NW: A prospective time-series quality improvement trial of a standardized analgesia protocol to reduce postoperative pain among neurosurgery patients. J Neurosurg 125:152315322016


Yeh YCReddy P: Clinical and economic evidence for intravenous acetaminophen. Pharmacotherapy 32:5595792012




All Time Past Year Past 30 Days
Abstract Views 220 220 220
Full Text Views 109 109 109
PDF Downloads 59 59 59
EPUB Downloads 0 0 0


Google Scholar