Intravenous Acetaminophen Said To Distinguish Benign Postcolorectal EMR Pain From Pain Potentially Reflecting Complications
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Intravenous Acetaminophen Said To Distinguish Benign Postcolorectal EMR Pain From Pain Potentially Reflecting Complications

Douglas K. Rex, MD, MASGE, reviewing Desomer L, et al. Endoscopy 2023 Jan 30.

In an observational study of colorectal EMR, 67 of 336 patients (19.9%) experienced postprocedural pain. All EMRs were performed with electrocautery and adrenaline injection. Pain was more common in female patients and patients with large lesions and with intraprocedural bleeding needing endoscopic control.

If patients had pain persisting for longer than 5 minutes and a review by the endoscopy team suggested no major complication, they were given 1 g of intravenous (IV) acetaminophen. If patients improved, the pain was labeled mild, and they were discharged after 4 hours of observation on a clear liquid diet. This was the course for 51 of 67 (76%) patients.

If pain persisted 30 minutes after IV acetaminophen, patients were reevaluated for obvious complications, and if none were present, they were given fentanyl, up to 100 µg total, in 25-µg increments. Eleven of 16 patients responded to this treatment and continued with outpatient recovery.

Five patients had persistent pain despite receiving IV acetaminophen and fentanyl and were hospitalized specifically for pain. Three of these patients included one patient with an intraprocedural perforation, one with CT evidence of serositis, and one with CT evidence of a perforation (minor extramural gas).

Douglas K. Rex, MD, FASGE

COMMENT

This report is consistent with my experience, which is that patients who experience significant pain while in the recovery area after colorectal EMR can be treated with small doses of an analgesic, and if they improve and their examination is benign, they can be discharged without fear of subsequent perforation. In our experience, we now seldom see post-EMR pain without the use of epinephrine in the submucosal injectate.

 

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Desomer L, Tate DJ, Pillay L, et al. Intravenous paracetamol for persistent pain after endoscopic mucosal resection discriminates patients at risk of adverse events and those who can be safely discharged. Endoscopy2023 Jan 30. (Epub ahead of print) (https://doi.org/10.1055/a-2022-6530)

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