Scheduled intravenous acetaminophen versus continuous intravenous fentanyl in postoperative analgesia following McKeown esophagectomy with thoracotomy and laparotomy: A pilot study

To determine whether the study protocol was appropriate for comparing the analgesic and adverse effects of postoperative fentanyl and acetaminophen transfusion following McKeown esophagectomy. In this prospective pilot study, patients who underwent McKeown esophagectomy with right thoracotomy and laparotomy between October 2015 and August 2017 received either continuous intravenous fentanyl (group A) or intravenous acetaminophen (group B) every 6 h. We evaluated pain intensity, number of daily rescue doses, nausea, vigilance, postoperative clinical course, and adverse events postoperatively. Four patients in group A dropped out owing to severe drowsiness. Pain intensity and number of rescue doses did not differ significantly, and the intensity of nausea was low in both groups. During postoperative days 1–3, vigilance was significantly better in group B (p = 0.004). The median duration for ambulation postoperatively was 2.0 days in both groups (p = 0.296). Postoperative complications ≥ Grade III Clavien-Dindo classification did not differ significantly between the groups. Although this study protocol was not feasible because 40% of the patients in the fentanyl group dropped out owing to severe drowsiness, our results show that acetaminophen significantly improved vigilance in the early postoperative period, and its analgesic effect was not significantly different from that of fentanyl. •This study compare the analgesic and side effects of acetaminophen and fentanyl.•Acetaminophen causes less drowsiness with similar analgesic effects than fentanyl.•Multimodal analgesic techniques are necessary after the fourth postoperative day.