In Reply

We welcome the thoughtful comments by Dr. Steadman and Riouet al., in reply to our study.1 We aimed to evaluate the use of IV acetaminophen and its association with outcomes including opioid utilization, opioid-related adverse effects, and cost and length of hospitalization. Dr. Steadman mentioned several limitations of our study —some justified (and mentioned in our study’s Limitations section) and some less so—and observational research in general. Dr. Steadman states that “A better study would be a randomized double-blinded one in which the only variable would be the use of IV acetaminophenversus oral acetaminophen for 24  h in a cohort of patients that did not include chronic opiate users, and in which the multimodal regimen was standardized rather than determined by individual predilections.” We agree that this would be an ideal study situation to a certain extent. However, such a study would be difficult to co nduct or would significantly lack generalizability, because common practice almost never is in alignment with the control group or intervention group. Indeed, multiple (nonopioid) modalities (e.g., nerve blocks, neuraxial analgesia, acetaminophen, and gabapentinoids, among others) are available for use in multimodal regimens; this results in an exponential increase in the number of potential combinations to use in practice.2 Therefore, there currently is no universally recognized standard regimen to be used in a trial desirous of generalizability, and ...
Source: Anesthesiology - Category: Anesthesiology Source Type: research