*Purpose: The purpose of this study was to determine if intravenous acetaminophen (IV APAP) use affects the daily and cumulative opioid requirements of patients undergoing laparoscopic donor nephrectomy.

*Methods: This study was a single-center, retrospective chart review of patients admitted to Saint Barnabas Medical Center for laparoscopic donor nephrectomy between January 1, 2015 – June 30, 2015 and January 1, 2019 – June 30, 2019. Patients were excluded if their procedure was converted to an open nephrectomy or if they used a pain regimen that included a continuous nerve block, dextromethorphan and/or pregabalin. The 2019 treatment group received IV APAP as part of their post-operative pain management; they were compared to a 2015 control group that did not receive IV APAP. The primary endpoint was cumulative opioid use during hospitalization. Secondary endpoints were: daily opioid use, length of stay (LOS), and 30-day readmission rate. Demographic data that was collected and assessed included age, gender, ethnicity, weight, and LOS. Medication-related data that was collected included: IV APAP doses, tramadol doses, discharge opioid prescriptions, and opioid use measured as oral morphine dose equivalents. Oral morphine dose equivalents were defined as: 30 mg of oral morphine = 100 mcg of IV fentanyl = 7.5 mg of oral hydromorphone = 20 mg of oral oxycodone. The Mann-Whitney test was used to analyze continuous ratio data and the Chi-square test was used to analyze discrete nominal data.

*Results: A total of 115 patients were included in the analysis (IV APAP treatment, n = 64; control, n = 51). There was a significant difference in the primary outcome of cumulative opioid use in the IV APAP treatment group vs the control group (96.3 mg vs 157.5 mg, p<0.001). The secondary outcome of daily opioid use was significantly lower in the treatment group on post-operative day (POD) 0 (30 mg vs 40 mg, p<0.001), POD 1 (43.5 mg vs 70 mg, p<0.001) and POD 2 (15 mg vs 32 mg, p<0.001). The secondary outcomes of average LOS and 30-day hospital readmission rate resulted in no statistical differences.

*Conclusions: There was a significant decrease in cumulative opioid use in patients who received IV APAP, although this finding may not be clinically significant. Further studies need to be conducted to understand the impact of opioid side effects and psycho-social concerns in laparoscopic donor nephrectomies.

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