Reid McCullough, DO
Resident Physician
University of Miami/Jackson Memorial Hospital
Miami, Florida, United States
Jeremy Jueng, MD
Resident Physician
University of Miami/Jackson Health System
Miami, Florida, United States
Matthew Burnett, BS
Medical Student
ATSU KCOM
Wichita, Kansas, United States
Jose R. Vives, MD
Assistant Professor / Attending Physician
University of Miami Miller School of Medicine / PM&R Department
Miami, Florida, United States
Patient is a 74 y.o. male status post elective L3-S1 laminectomy with instrumentation and fusion/decompression due to lumbar spine stenosis with neurogenic claudication. Upon arrival to the acute rehabilitation facility (ARF), significant pain was hindering patient’s participation in therapy. He required a total of 25 mg of Oxycodone and 0.5 mg of Hydromorphone daily upon arrival [40 Morphine Milligram Equivalents (MME)]. Patient was started on intravenous (IV) Acetaminophen every eight hours for lumbar pain refractory to high-dose opioids. Following 24 hours of IV Acetaminophen, the patient’s pain significantly improved, participated in full therapy sessions, and requested an average of 10 mg Oxycodone daily (15 MME).
Discussions:
The use of IV acetaminophen continues to be a controversial topic amongst practitioners of all fields. This case offers evidence for the use of IV acetaminophen in patients with debilitating pain following lumbar fusion refractory to high-dose opioids and are admitted to acute rehabilitation facilities. Many IV acetaminophen studies have discussed outcomes in a myriad of different surgical procedures. To the best of our knowledge, there is no study evaluating the outcomes of IV acetaminophen in lumbar fusion patients at least 3-4 days post-op admitted to ARFs. To date, many patients status post spinal surgeries admitted to our ARF have shown significant pain and therapy participation improvement following the initiation of IV acetaminophen. This study aims to guide future, larger studies in unraveling the effects of IV acetaminophen on patients admitted to ARFs following elective lumbar fusions.
Conclusions:
We present a lumbar fusion patient with pain refractory to high-dose opioids and limited therapy participation. His pain significantly improved following the initiation of IV acetaminophen. To the best of our knowledge, there are no recent articles discussing the use of IV acetaminophen for refractory pain in ARF patients following elective lumbar fusions.
