Efficacy of acetaminophen for pain management following total joint arthroplasty: Systematic review and network meta-analysis.

Background

Acetaminophen is widely used in multimodal analgesia after total joint arthroplasty (TJA), but the comparative effects of different regimens remain uncertain.

Methods

PubMed, Embase, Cochrane Library, and Web of Science were searched through September 22, 2025 for randomized controlled trials evaluating acetaminophen or propacetamol regimens after total hip or knee arthroplasty. A Bayesian network meta-analysis was performed using R 4.4.0 and JAGS 4.3.1. Outcomes included pain scores at 6, 12, and 24 h and 24 h supplemental analgesic consumption, expressed as standardized mean differences (SMDs) with 95% credible intervals (CrIs).

Results

Fifteen RCTs including 1986 patients and six interventions were analyzed. For 24 h supplemental analgesic consumption, multiple-dose intravenous propacetamol and multiple-dose intravenous acetaminophen ranked highest (SUCRA 90.37% and 86.94%) and were superior to control (SMD 0.49 [0.18, 0.81] and 0.45 [0.27, 0.63], respectively). For 24 h pain, multiple oral and multiple intravenous acetaminophen reduced scores versus control (SMD 0.25 [0.05, 0.45] and 0.18 [0.005, 0.35], respectively). No significant differences were found at 12 h. At 6 h, multiple-dose intravenous propacetamol showed the largest effect (SMD 0.96 [0.49, 1.42]).

Conclusions

Acetaminophen-based regimens may provide modest postoperative analgesic and opioid-sparing benefits after TJA, particularly with selected multiple-dose intravenous protocols. However, no single regimen was consistently superior across outcomes and time points, and SUCRA rankings should be interpreted alongside effect estimates and clinical feasibility.