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Objective Examination of postoperative analgesia with intravenous and oral acetaminophen. Design Prospective, three-arm, nonblinded, randomized clinical trial. Setting A single academic medical center. Subjects Parturients scheduled for elective cesarean delivery. Methods This trial randomized 141 parturients to receive intravenous acetaminophen (1 g every eight hours, three doses), oral acetaminophen (1 g every eight hours, three doses), or no acetaminophen. All patients received a standardized neuraxial anesthetic with intrathecal opioids and scheduled postoperative ketorolac. The primary outcome, 24-hour opioid consumption, was evaluated using the Kruskal-Wallace test and Tukey-Kramer adjustment for multiple comparisons. Secondary outcomes included 48-hour opioid consumption, first opioid rescue, pain scores, patient satisfaction, times to ambulation and discharge, and side effects. Results Over 18 months, 141 parturients with similar demographic variables completed the study. Median (interquartile range) opioid consumption in intravenous morphine milligram equivalents at 24 hours was 0 (5), 0 (7), and 5 (7) for the intravenous, oral, and no groups, respectively, and differed between groups (global P  = 0.017). Opioid consumption and other secondary outcomes did not differ between the intravenous vs oral or oral vs no groups. Opioid consumption was reduced at 24 hours with intravenous vs no acetaminophen (P  = 0.015). Patients receiving no acetaminophen had 5.8 times the odds of consuming opioids (P  = 0.036), consumed 40% more opioids controlling for time (P  = 0.041), and had higher pain scores with ambulation (P  = 0.004) compared with the intravenous group. Conclusions Intravenous acetaminophen did not reduce 24-hour opioid consumption or other outcomes compared with oral acetaminophen. Intravenous acetaminophen did decrease opioid consumption and pain scores compared with no acetaminophen. [ABSTRACT FROM AUTHOR]

Objective. Examination of the effectiveness of perineural dexamethasone administered in very low and low doses on ropivacaine brachial plexus block duration. Design. Retrospective evaluation of brachial plexus block duration in a large cohort of patients receiving peripheral nerve blocks with and without perineural dexamethasone in a prospectively collected quality assurance database. Setting. A single academic medical center. Methods. A total of 1,942 brachial plexus blocks placed over a 16-month period were reviewed. Demographics, nerve block location, and perineural dexamethasone utilization and dose were examined in relation to block duration. Perineural dexamethasone was examined as none (0 mg), very low dose (2mg or less), and low dose (greater than 2mg to 4 mg). Continuous catheter techniques, local anesthetics other than ropivacaine, and block locations with fewer than 15 subjects were excluded. Associations between block duration and predictors of interest were examined using multivariable regression models. A subgroup analysis of the impact of receiving dexamethasone on block duration within each block type was also conducted using a univariate linear regression approach. Results. A total of 1,027 subjects were evaluated. More than 90% of brachial plexus blocks contained perineural dexamethasone ( ≤ 4 mg), with a median dose of 2 mg. Increased block duration was associated with receiving any dose of perineural dexamethasone (P< 0.0001), female gender (P=0.022), increased age (P=0.048), and increased local anesthetic dose (P=0.01). In a multivariable model, block duration did not differ with very low- or lowdose perineural dexamethasone after controlling for other factors (P=0.420). Conclusion. Perineural dexamethasone prolonged block duration compared with ropivacaine alone; however, duration was not greater with low-dose compared with very low-dose perineural dexamethasone. [ABSTRACT FROM AUTHOR]