Date Available

4-29-2020

Year of Publication

2020

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Melanie Hardin-Pierce

Committee Member

Dr. Sheila Melander

Committee Member

Dr. Ayesha Ather & Dr. Komal Pandya

Co-Director of Graduate Studies

Dr. Linda Clements

Abstract

The Effects of Scheduled Acetaminophen and Methocarbamol Administration on Postoperative Opioid Use and Related Side Effects Among Cardiac Surgery Patients

ABSTRACT

Purpose

Opioid therapy is commonly prescribed to combat surgical pain in hospitals across the United States and is associated with many negative side effects including dependence and nausea. The purpose of this study was to retrospectively examine the effects of scheduling acetaminophen and methocarbamol administration postoperatively throughout the cardiac surgery patients’ hospital stay. Through retrospective chart reviews, the aims of postoperative opioid use, postoperative opioid use according to hospital length of stay, antiemetic use, and opioid prescription at discharge were compared between two cohorts: a scheduled acetaminophen and methocarbamol cohort and a non-scheduled acetaminophen and methocarbamol cohort.

Setting & Population

The study takes place at The University of Kentucky’s Cardiovascular Intensive Care Unit and telemetry floors at Albert B. Chandler Medical Center in Lexington, Kentucky. The target population included coronary artery bypass graft and valve replacement surgical patients. A total of 77 patients were included in this retrospective study divided into two cohorts. The scheduled cohort had 27 patients and the non-scheduled cohort had 50. Exclusion criteria were patients less than 18 years of age, patients expiring during their hospital stay, patients on postoperative opioid PCAs/ continuous opioid infusions, patients diagnosed with chronic pain disorders or opioid use disorder, patients with a hospital length of stay greater than 14 days, and patients requiring mechanical circulatory support postoperatively . The mean age for scheduled cohort was 60.8 while non-scheduled was 59.5 while 97.4 percent of the participants were white.

Results

The scheduled cohort had a sum of opioids mean of 23.5 and the non-scheduled cohort had a sum of opioids mean of 25.5. There was no significant difference in means between the two cohorts (p= .47). There was no significant difference between the two cohorts of hospital length of stay less than one week and greater than one week (p=.07, .533 respectively); however, less than one week scheduled had a mean sum of opioids of 15.6 while non- scheduled less than one week had a mean sum of opioids of 22.1; clinical relevance is further discussed. No significant association existed (p= .753) between those discharged home on opioids between the two cohorts; however, another aspect of clinical relevance is discussed. No significant difference between the two cohorts and antiemetic use (p= .107).

Conclusion

Limitations to the study included the setting being a single center study with a minimally diverse patient population and strict inclusion/ exclusion criteria that impeded sample size. When developing future studies, consideration should be given to hospital LOS due to this study’s clinically relevant findings. Future research is needed for cardiac surgery patients and ways to mitigate those discharged home on opioids. Future studies could alter the “scheduling” definition to include patients receiving acetaminophen and methocarbamol greater than or equal to four times in a 24-hour period (+ or – four hours). Future research could also include more in-depth communication among all disciplines involved including ways to mitigate the technological errors encountered in this study. Dissemination of the surgical guidelines published by the American Pain Society (2016) and The Enhanced Recovery After Surgery Society (2019) that promote scheduling acetaminophen postoperatively could occur in an educational in-person session to the cardiac surgery service line and serve as beneficial along with this study’s clinically relevant findings. Notable ethical concerns include the primary investigator’s employment as a nurse within UK’s Cardiovascular Intensive Care Unit. This study contributes to the knowledge of the effects related to scheduling postoperative acetaminophen and methocarbamol among cardiac surgery patients and has the potential to offer insight on future study designs.

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