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Postoperative pain management using high-dose oral acetaminophen for enhanced recovery after colorectal cancer
Shinya Urakawa1,2, Tatsushi Shingai3,4, Junichiro Kato3
1Department of Gastroenterological Surgery, Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka, 565-0862, Japan. urashin.1130@gmail.com.
Purpose:
Postoperative pain management is important for enhanced recovery. High-dose oral acetaminophen is effective; however, the safety of its long-term use has not been established in gastrointestinal surgeries. This study aimed to investigate drug-induced liver injury (DILI) in patients with colorectal cancer using high-dose acetaminophen.
Methods:
One hundred sixty-eight consecutive colorectal cancer using high-dose oral acetaminophen (3600 mg/day between postoperative day 1 and 7) were enrolled.
Results:
One hundred forty-nine patients (88.7%) completed the administration of high-dose oral acetaminophen. DILI occurred in 58 patients (34.5%), and the cumulative incidence rates were 20.4% and 37.9% on postoperative 6 and 7, respectively. The severity of liver injury was grade 1 in all cases and returned to normal without treatment. Patients with DILI had a higher frequency of dyslipidemia (44.8% vs. 23.6%, P = 0.0047) and M1 staging (10.3% vs. 1.0%, P = 0.0036). A multivariate analysis showed that the presence of dyslipidemia (OR 2.61, P = 0.0067) and M1 stage (OR 12.4, P = 0.0053) were independent risk factors for DILI.
Conclusion:
The long-term use of high-dose oral acetaminophen in colorectal cancer patients enrolled in enhanced recovery protocols is feasible. Moreover, the presence of dyslipidemia and M status are risk factors for DILI.
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