SHM Converge Conference Coverage

Can Intravenous Acetaminophen Reduce Opioid Use and Accelerate Recovery for Patients With Small Bowel Obstruction?

Anthony Calabro, MA

Key Highlights

  • Intravenous (IV) acetaminophen use was associated with lower opioid consumption during hospitalization.
  • The treatment group showed trends toward faster resolution of small bowel obstruction (SBO) and shorter hospital stays.
  • Statistical significance was not reached, highlighting the need for larger trials.

In a randomized controlled trial presented at the Society of Hospital Medicine Converge in Las Vegas, NV, researchers evaluating pain management strategies in SBO found that IV acetaminophen demonstrated favorable trends in reducing opioid consumption, shortening hospital stays, and accelerating resolution of obstruction. Importantly, the findings did not reach statistical significance, likely due to the study’s small sample size.

Given the opioid epidemic and the negative impact of opioids on gastrointestinal recovery, identifying non-opioid alternatives for pain control in SBO is of clinical importance.

This double-blind, prospective, randomized, placebo-controlled trial was conducted at Mayo Clinic Jacksonville from September 2023 to October 2024. A total of 18 patients admitted for nonsurgical SBO were randomly assigned to receive either IV acetaminophen (1 g every 6 hours for 2 days and every 8 hours on day 3) or placebo (normal saline). All patients were eligible to receive additional opioid analgesics per physician discretion.

Pain was assessed using a subjective 0–10 scale, and opioid use was standardized into morphine milligram equivalents (MME). The primary outcomes included trial feasibility, pain scores, opioid use, time to resolution of SBO, hospital stay duration, and 30-day mortality. Secondary outcomes included complications and adverse events. Patients with chronic opioid use were excluded.

The demographic and clinical profiles were similar between the two groups. Notably, the treatment group reported numerically lower pain scores across all 3 days of the trial (Day 1: 2.8 vs 4.2; Day 2: 3.5 vs 4.2; Day 3: 2.1 vs 5), although differences were not statistically significant.

Opioid consumption during the study was lower in the acetaminophen group (9.1 MME vs 17.3 MME), and the time to SBO resolution was faster (1 day vs 2 days, P = .061). Median hospital stay was also shorter in the treatment arm (3 vs 5 days), and no adverse events or major complications, including bowel perforation, allergic reactions, or delirium, were observed.

“Larger studies are needed to confirm these findings and further evaluate IV acetaminophen’s role in reducing opioid use, improving patient safety, and minimizing opioid-related adverse effects,” the authors concluded.

Reference
Gavrancic T, Tahir W, Murawska-Baptista A, et al. A randomized, double-blind, placebo-controlled clinical trial of intravenous acetaminophen use for pain management in small bowel obstruction: interim analysis of feasibility and outcomes. J Hosp Med. 2025;Abstract 0117. Abstract presented at: SHM Converge 2025. https://shmabstracts.org/abstract/a-randomized-double-blind-placebo-controlled-clinical-trial-of-intravenous-acetaminophen-use-for-pain-management-in-small-bowel-obstruction-interim-analysis-of-feasibility-and-outcomes/