This document summarizes a study evaluating the use of intravenous acetaminophen (Ofirmev) compared to no intravenous acetaminophen on 400 surgery patients in a post-anesthesia care unit. The results found that patients who received Ofirmev had higher average pain scores and used more opiate pain medications than those who did not receive Ofirmev. The document concludes that intravenous acetaminophen does not reduce the need for other pain medications and opiates in the post-anesthesia care unit compared to oral or rectal formulations of acetaminophen, which would provide similar pain relief at a lower cost.

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Hypothesis: Ofirmev will reduce the need for other pain medications and opiates for surgery patients in
the post-anesthesia care unit (PACU).
Drug: Ofirmev (acetaminophen) IV 1000mg/100ml.
Objective: Evaluate utilization of Ofirmev and correlate data points (pain scores and use of pain
medications, opiates while in the PACU).
Methods of data collection: Collection of the following data points were done by reviewing patient
records of surgery and PACU reports via Meditech: type of surgery, name of surgeon, pre-operative pain
score, total minutes in PACU, pain scores while in PACU, use of epidural, ketorolac, patient controlled
analgesics (PCA), and opiates (reported in morphine equivalents). Date of surgeries ranged from
September to December 2014 and sample size of 400 patients were obtained, 200 patients in the Ofirmev
group and 200 in the non-Ofirmev group.
Results:
Table 1. Results of patients receiving Ofirmev versus no Ofirmev. Average pain scores pre-operative, minutes in
PACU, average pain in PACU, average morphine equivalents of opiates used, and number of epidurals and PCA’s.
Ofirmev No Ofirmev
Average pre-operative
pain score 1.86 2.16
Average PACU time (minutes)
111.39 109.565
Average pain in PACU
3.5 2.65
Average ME in PACU
*ME=morphine equivalent 18.83 12.98
# Epidurals
8 10
# PCAs
12 9
Results of data collection show there is not less utilization of pain medications and opiates in Ofirmev
versus non-Ofirmev users.
Medication Utilization Evaluation of Ofirmev
Research Medical Center
Hospital Corporation of America (HCA) Midwest Health

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The types of surgeries varied; however amongst the Ofirmev versus Non-ofirmev patients, there were an
equal number of procedures collected per group. Surgeries included in the tally include the following:
Table 2. Summary of surgical procedures tallied in the Ofirmev MUE.
Procedure Ofirmev No Ofirmev
Atrial fibrillation ablation 1 1
Burn excision/graft 6 10
Carotid endarterectomy 0 3
Colectomy 8 7
Discectomy 27 26
Hardware removal 1 2
Hemi colectomy 3 1
Hernia repair 11 15
Hysterectomy 13 11
Hysterectomy/salpingo
oophrectomy
13 13
Intermedullary rodding 1 1
Kidney transplant 1 1
Knee arthroplasty 2 0
Knee arthroscopy 2 2
Laparoscopic cholecystectomy 17 12
Laparoscopic tubal ligation 1 4
Masectomy 2 2
ORIF (ankle, femur, humerus) 8 8
Popliteal bypass/graft 5 3
Shoulder arthroplasty 3 4
Shoulder arthroscopy 1 0
Suction dilatation and curettage 3 4
Wound debridement 3 6
Laminectomy/lumbar fusion 6 5
Total knee arthroplasty 5 3
Parathyroidectomy/thyoidectomy 2 4
Cervical fusion 0 3
Bronchoscopy 3 3
Laparoscopic ectopic removal 2 0
Hysteroscopy (ablation) 4 4
Laparoscopic nephrectomy 2 2
Exploratory laparotomy 5 4
Cystoscopy 0 2
Thrombectomy 1 2
Knee amputation 1 1
Laparoscopic hepatic
segmentectomy
1 1
Mass resection (tumor) 6 6
Other 30 24
Total Procedures 200 200

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*Total of 207 because some surgeries involved more than one anesthesiologist
Discussion, Conclusion, and Recommendation:
Ofirmev inhibits prostaglandins and opiates work on mu receptors each agent has it role in pain control for
surgical patients. In theory, the use of both will provide better analgesia, however the results from 400
patient profiles show that Ofirmev does not reduce the need for pain medications and opiates in the PACU.
Since patient records were not tallied beyond the PACU, it cannot be said that there was an overall
reduction in opiate use 24 hours post-surgery. Data from the drug manufacturer suggests a reduction of
opiate use 24 hours after knee and hip surgery. The manufacturer also states that pain score intensities
were reduced, but only by 0.6 to 1 on the pain scale, which is not clinically significant.
Regardless of type of surgery, opiate use was still required, and according to data collected, required more
opiates for pain control in the Ofirmev group (18.83 versus 12.98 morphine equivalents). Some reasons for
this could include patient’s individual pain score evaluations pre-operative. If a patient is already in pain,
and has already received opiates, the adjunctive med order for Ofirmev was ordered in hopes of reduction
of pain. However, in actuality the Ofirmev group in this MUE utilized on average 5.85 more morphine
equivalent opiates as compared with the non-Ofirmev group.
If there is a need for acetaminophen use, then oral or rectal formulations are recommended. The IV
formulation has a quicker onset of action, but all formulations have about the same duration of action, 4 to 6
hours. The minute clinical benefit does not outweigh the cost difference of utilizing IV acetaminophen
(Ofirmev) versus using oral or rectal acetaminophen.
Surgeons with Ofirmev use (greater than or
equal to) 10 patients:
1. Basta
2. Blatt
3. Cates
4. Garcia
5. Hicks
6. Taghizadeh
Anesthesiologist with Ofirmev use:
Anesthesiologist # of patients
Armstrong 13
Berenson 24
Bernard 12
Bruening 25
Freund 16
Gassin 16
Ludwikosky 25
Moncure 28
Moore 22
Novak 16
Powers 10

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Ofirmev
(IV APAP)
Cost per
1000mg/100ml
Oral APAP
Cost per
650mg, two
325mg tablets
Rectal APAP
Cost per
650mg rectal
suppository
Cost per 200
patients
Cost per 200
patients
Cost per 200
patients
$33.70 $0.0089 $0.16 $6740.00 $1.78 $32.00
*APAP=acetaminophen
Cost Savings if switched to Oral or Rectal APAP
per 200 patients
Ofirmev-> Oral APAP Ofirmev-> Rectal APAP
$6738.22 $6708