Project 462410

Pain is an important but difficult part of patient management after heart surgery. Besides the obvious humane need to avoid suffering, uncontrolled pain slows recovery and increases complications. Opioid drugs (such as morphine) are currently the first-line therapy. They work well at relieving pain but have their own problems. They make patients sleepy and confused and this can delay removal of the breathing tube used for surgery, slow recovery, and even lead to long-term dependency. A particularly distressful consequence of opioids can be hallucinations, thoughts that do not make sense, and an inability to concentrate on tasks. This is called delirium. Delirium is associated with prolonged hospital stays, increased risk of developing pneumonia, and even long-term decreases in mental function. An effective alternative to opioids is thus needed. One possibility is non-steroidal anti-inflammatory agents, or NSAIDs. Two of these are the commonly used Naproxen and Ibuprofen. Unfortunately, these cannot be used after heart surgery because they increase the risks of both bleeding and clot formation and can reduce kidney function. Oral acetaminophen (Tylenol) is also used but it is not very potent. Recently, an intravenous (IV) form of acetaminophen has become available. We think this IV form may be more potent than the pill form and with minimal side effects. However, it is considerably more expensive. Our goal is to determine if IV acetaminophen can control post-op pain, reduce use of opioids and thereby reduce the incidence of delirium--all at a reasonable cost. To do this, patients will be given either IV acetaminophen and a placebo (sugar) pill, or an IV solution with no acetaminophen and a real acetaminophen pill in the first 2 days after surgery. Neither the treating team nor the patient will know which treatment is given. IV acetaminophen will be considered effective if patients who receive it have fewer episodes of delirium compared to those who do not.