Oral paracetamol premedication: a proposal for increasing its use

ABSTRACT

Peri-operative intravenous paracetamol use has not been shown to be superior to oral administration in a randomised controlled trial looking at postoperative pain [1]. The use of intravenous paracetamol carries a wellrecognised increased financial and environmental cost compared to oral paracetamol. We audited the use of paracetamol in patients attending theatre at a district general hospital and propose a method to increase premedication with oral paracetamol. Methods We retrospectively audited the notes of all patients who underwent an elective surgical procedure in theatres, across a 5-day period at a district general hospital. Data regarding the use of paracetamol were collected. Patients who were already an inpatient and those having surgery under local anaesthetic alone were excluded. Results Forty-seven patients were included, five of whom had a spinal and 42 a general anaesthetic with representation from six different surgical specialities. Five of the patients included were under 18 years. Thirty-seven patients received paracetamol peri-operatively. Thirty-four patients received only intravenous paracetamol, two patients received oral paracetamol and one patient received both due to length of time between preoperative oral dose and surgery. Ten patients did not receive any paracetamol. No patients included had a documented allergy or contraindication to paracetamol. Discussion Our department recognised the financial and environmental benefits associated with oral pre-medication. Although many of these anaesthetists would prefer to prescribe pre-operative analgesia, the data indicate that there are barriers that prevent prescription and/or administration. As a result of the COVID-19 pandemic, elective orthopaedic surgery with an enhanced recovery protocol including the use of oral paracetamol premedication, was underrepresented in our data. Previous encouragement to prescribe oral premedication has produced good, short-term results but does not appear to provide long-lasting change. We propose a Patient Group Directive for the administration of pre-operative oral paracetamol by the admitting nurse on arrival to the pre-operative ward. We anticipate that this will both standardise and embed oral paracetamol premedication into the department and will therefore provide long-term change.