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STUDY OBJECTIVE: The primary aim was to compare postoperative pain scores in patients undergoing laparoscopic cholecystectomy and receiving intravenous (IV) or oral (PO) acetaminophen (APAP) as part of a multimodal analgesic regimen to examine whether PO APAP is non-inferior to IV APAP. DESIGN: Retrospective analysis. SETTING: Ambulatory surgical center (ASC) in an academic setting. PATIENTS: 579 patients (18-70 years old), American Society of Anesthesiologists physical status I-III, undergoing laparoscopic cholecystectomy. INTERVENTIONS: Patients received 1,000 mg IV APAP intraoperatively (n = 319) or 1,000 mg PO APAP preoperatively (n = 260). MEASUREMENTS: The primary outcome was the median difference in post-anesthesia care unit (PACU) end-pain scores between the groups. Median pain scores were also compared on PACU admission, and at 15, 30, 45, and 60 minutes. Additional measures include PACU rescue-analgesia consumption, time to first PACU rescue analgesia, intraoperative use of opioid and nonopioid analgesics, PACU length of stay, and PACU rescue nausea and vomiting therapy. MAIN RESULTS: In both groups, the PACU median end-pain score was 2. The 90% confidence interval (CI) for difference in median pain scores between groups was [0, 0]; the CI upper limit was below the non-inferior margin of 1 pain-score point, indicating PO APAP's non-inferiority to IV APAP. There were no statistically significant differences in the percentages of patients receiving PACU hydromorphone equivalents between the IV and PO groups (75% vs. 77%, P = 0.72) or in the mean dose received (0.5 mg vs. 0.5 mg, P = 0.66). CONCLUSION: Single-dose PO APAP is non-inferior to IV APAP for postoperative analgesia in ASC laparoscopic cholecystectomy patients. The value of single-dose IV APAP in this population should be further explored.
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Syed-Abdul, MM, Soni, DS, Miller, WM, Johnson, RJ, Barnes, JT, Pujol, TJ, and Wagganer, JD. Traditional versus suspended push-up muscle activation in athletes and sedentary women. J Strength Cond Res 32(7): 1816-1820, 2018-Many strength training programs incorporate push-up exercises, which primarily activate upper-body muscles. Past data support the fact that shoulder girdle muscles (i.e., triceps (T) and anterior deltoids [AD]) exhibit greater electromyography (EMG) activity when a push-up is performed on an unstable (i.e., suspended [SP]) vs. stable (i.e., traditional [TD]) surface (). Sixty-nine healthy female volunteers (soccer players [SO], n = 24; gymnasts [GY], n = 21; sedentary [SE], n = 24) performed three TD and three SP push-ups. Muscle activation, expressed as absolute integral (mV), was measured using EMG analysis. Significant increases in muscle activation were exhibited by GY (TD: p < 0.01 and SP: p < 0.001) and SO (TD: p < 0.05 and SP: p < 0.05) compared to SE for the T muscle. Only SO (p < 0.05) exhibited significantly higher muscle activation during the SP versus TD. For the AD, values were significantly higher for SO (TD: p < 0.001 and SP: p < 0.001) and GY (TD: p < 0.01 and SP: p < 0.01) compared to the SE group. In addition, significantly higher values were exhibited by SO compared with GY during TD push-ups (p < 0.01). Both the SO (p < 0.05) and GY (p < 0.05) group exhibited significantly higher values during SP versus TD push-ups. Finally, values were significantly higher for the AD compared to the T muscle only in the SO group during TD (p < 0.01) and SP (p < 0.05) push-ups. Data from this study for trained women (i.e., SO) are consistent with previous studies, whereas for untrained women (i.e., SE) the findings differed during TD and SP push-ups for both muscles. Differences were also observed between female SO and GY are unexplainable and therefore need further investigation.