Is IV Paracetamol A Pain?

Abstract

Background

Before 2005, Australia only had access to oral and rectal formulations of paracetamol. Since becoming available in Australia, intravenous paracetamol use has steadily increased. This is problematic because it provides minimal benefit over oral paracetamol for many patients1, is 100-fold more costly, resource intensive to administer and has a larger carbon footprint.2,3

Aim

To investigate intravenous paracetamol usage at Austin Health, examine its environmental impact and determine strategies to minimise its use.

Methods

Intravenous paracetamol usage, as 1-gram units, from 2005 to 2023 was determined, and carbon emissions were calculated and compared to emissions from the same number of tablets. Strategies to minimise intravenous paracetamol use were determined with consideration to barriers and enablers for oral paracetamol use, and ‘who needs to do what differently, when, where, how and with whom?’4

Results

330,448 1-gram units of intravenous paracetamol were administered, generating ~203 tonnes of CO2e. This compares to ~1.2 TCO2e, had oral paracetamol tablets been given. The extra carbon emissions generated from intravenous over oral paracetamol use is equivalent to emissions from a light SUV travelling 1,335,372km.5

Strategies identified to reduce intravenous paracetamol use include removing stock from ward imprests, shelf-talkers detailing its carbon footprint and an awareness campaign with a Grand Round Clinical Pearl presentation. Stakeholders, clinical champions and opinion leaders have been engaged to support the initiative.

Conclusion

The carbon emission from intravenous over oral paracetamol use was equivalent to almost 90 'big laps' around Australia by a light SUV. Initial strategies to minimise intravenous paracetamol use are being implemented. Further initiatives, including electronic medication management strategies, are being explored.

Impact

This work highlights the impact of a higher carbon footprint medication formulation on the environment and sought strategies to facilitate switching over to a lower carbon footprint formulation that is as efficacious for most patients.

Mallama M, Valencia A, Rijs K, Rietdijk WJR, Klimek M, Calvache JA. A systematic review and trial sequential analysis of intravenous vs. oral peri-operative paracetamol. Anaesthesia. 2021 Feb;76(2):270-276. doi: 10.1111/anae.15163. Epub 2020 Jun 18. PMID: 32557588; PMCID: PMC7818191.

Davies JF, McAlister S, Eckelman MJ, McGain F, Seglenieks R, Gutman EN, Groome J, Palipane N, Latoff K, Nielsen D, Sherman JD; TRA2SH, GASP, and WAAREN collaborators. Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis. Br J Anaesth. 2024 Jan 30:S0007-0912(23)00725-0. doi: 10.1016/j.bja.2023.11.053. Epub ahead of print. PMID: 38296752.

Myo, J., Pooley, S. and Brennan, F. (2021), Oral, in place of intravenous, paracetamol as the new normal for elective cases. Anaesthesia, 76: 1143-1144. https://doi.org/10.1111/anae.15482

Atkins, L., Francis, J., Islam, R. et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Sci 12, 77 (2017). https://doi.org/10.1186/s13012-017-0605-9

Carbon emissions for a light SUV calculated using: Carbon Dioxide Emissions Intensity for New Australian Light Vehicles 2021. National Transport Commission. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ntc.gov.au/sites/default/files/assets/files/Carbon%20Dioxide%20Emissions%20Intensity%20for%20New%20Australian%20Light%20Vehicles%202021.pdf. Date accessed: 22/05/24