Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2025; 16(4): 104452
Published online Apr 18, 2025. doi: 10.5312/wjo.v16.i4.104452
Effectiveness of oral vs intravenous acetaminophen on pain management following total joint arthroplasty: A systematic review and meta-analysis
Bin Lu, Ai-Xian Tian, Zheng-Rui Fan, Xing-Wen Zhao, Hong-Zhen Jin, Jian-Xiong Ma, Xin-Long Ma
Bin Lu, Ai-Xian Tian, Zheng-Rui Fan, Xing-Wen Zhao, Hong-Zhen Jin, Jian-Xiong Ma, Xin-Long Ma, Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
Author contributions: All authors certified that they have participated in the conceptual design of this work, the analysis of the data, and the writing of the manuscript to take public responsibility for it; Lu B and Tian AX drafted the protocol and wrote the final paper; Ma JX and Ma XL contributed to the research design and made critical revisions; Fan ZR, Zhao XW and Jin HZ participated in data collection; Lu B and Tian AX participated in the data analysis; all authors reviewed the final version of the manuscript and approve it for publication.
Supported by National Natural Science Foundation of China, No. 11772226 and No. 81572154.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Long Ma, Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, No. 155 Munan Road Heping District, Tianjin 300050, China. maxinlong8686@sina.com
Received: December 24, 2024
Revised: March 5, 2025
Accepted: April 1, 2025
Published online: April 18, 2025
Processing time: 117 Days and 23.2 Hours
Abstract
BACKGROUND

In the management of postoperative pain following total joint arthroplasty (TJA), the use of nonsteroidal anti-inflammatory drugs, including acetaminophen, plays a key role in alleviating pain. However, the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.

AIM

To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.

METHODS

PubMed, Embase and the Cochrane Library were comprehensively searched to identify cohort studies. The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials. PRISMA guidelines were followed. The effectiveness of the administration routes was compared based on visual analogue scale (VAS) scores at 24 and 48 h, total morphine usage within 24 h, and total duration of hospital stay.

RESULTS

The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups. The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h (P = 0.76 and 0.08, respectively). The difference in total morphine use between the two groups was not significant (P = 0.22). However, the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups (P = 0.0005), showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.

CONCLUSION

After TJA surgery, intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia, Oral administration has become the preferred choice for mild cases due to its convenience and economy, providing a basis for clinical drug selection.

Keywords: Joint arthroplasty; Pain management; Meta-analysis; Acetaminophen; Nonsteroidal anti-inflammatory drugs

Core Tip: Oral acetaminophen shows similar pain management after total joint arthroplasty (TJA) which compared with intravenous acetaminophen. Intravenous acetaminophen was not found to be superior to oral acetaminophen in patients undergoing TJA in terms of visual analogue scale score at 24, 48 h, total morphine consumption. However, it can significantly reduce the length of hospital stay. Higher-quality randomized controlled trials are required for further research in the future.