Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Intravenous Acetaminophen on Post-operative Pain and Narcotic Consumption in Vaginal Reconstructive Surgery Patients: A Randomized Controlled Trial
Brief Summary: This randomized controlled trial will evaluate the effects of perioperative intravenous (IV) acetaminophen on postoperative narcotic consumption and pain scores in subjects undergoing vaginal reconstructive surgery. One hundred subjects will be randomly assigned to receive either IV acetaminophen or IV placebo. Those in the IV acetaminophen group will receive 1000mg IV every 6 hours for 24 hours beginning prior to anesthesia induction. The control group will receive placebo saline infusions at the same time intervals. All subjects will receive as needed (prn) IV narcotic for additional pain relief. Visual analog scales (VAS) regarding pain will be evaluated at 18 and 24 hours postoperative and immediately prior to discharge. We will also collect total IV narcotic consumption. We hypothesize that subjects receiving IV acetaminophen will have lower VAS scores and decreased total narcotic consumption in comparison to the control group.


Options:
A: Inclusion Criteria:

* Women between the ages of 18 and 70 years
* Patients of the Division of Urogynecology at Good Samaritan and Bethesda North Hospitals in Cincinnati, Ohio
* Scheduled to undergo major vaginal reconstruction
* Must undergo total vaginal hysterectomy, anterior repair, posterior repair, enterocele repair, and intraperitoneal vault suspension. The addition of suburethral sling is not a cause for exclusion.

Exclusion Criteria:

* Allergy to acetaminophen
* Liver disease (chronic or active)
* Chronic alcohol use (\>1 drink/day)
* Bleeding diathesis
* Renal disease
* Opiate dependent or daily use
* History of chronic pain
* Mental or cognitive disorder preventing patient to accurately verbalize pain levels
* Undergoing abdominal or laparoscopic procedures at the time of surgery
* Allergy to hydromorphone
* Surgery is not performed under general anesthesia
B: Inclusion Criteria:

* Stage 2 to 4 prolapse
* Prolapse of the vaginal apex or cervix to at least half way into the vaginal canal (POPQ Point C \> -TVL/2) \[TVL stands for total vaginal length\]
* Vaginal bulge symptoms as indicated by an affirmative response to either questions on the Pelvic Floor Distress Inventory (PFDI)
* Vaginal surgery for prolapse is planned, including a vaginal apical suspension procedure.
* Stress incontinence symptoms as indicated by an affirmative response to the PFDI Stress incontinence subscale
* Documentation of transurethral stress leakage on an office stress test or urodynamics with or without prolapse reduction within the previous 12 months
* A tension free vaginal tape (TVT) is planned to treat stress urinary incontinence.
* A pelvic muscle training (PMT) visit can be performed at least 2 weeks and not more than 4 weeks before surgery.
* Available for 24-months of follow-up.
* Able to complete study assessments, per clinician judgment
* Able and willing to provide written informed consent

Exclusion Criteria:

* Contraindication to sacrospinous ligament fixation (SSLF), uterosacral vaginal vault ligament suspension (ULS), or TVT in the opinion of the treating surgeon.
* History of previous surgery that included a SSLF or ULS. (Previous vaginal vault suspensions using other techniques or in which the previous technique is unknown are eligible.)
* Pelvic pain or dyspareunia due to levator ani spasm that would preclude a PMT program.
* History of previous synthetic sling procedure for stress incontinence.
* Previous adverse reaction to synthetic mesh.
* Urethral diverticulum, current or previous (i.e., repaired)
* History of femoral to femoral bypass.
* Current cytotoxic chemotherapy or current or history of pelvic radiation therapy.
* History of two inpatient hospitalizations for medical comorbidities in the previous 12 months.
* Subject wishes to retain her uterus. \[Both ULS and SLS include removal of the uterus, if not previously removed\]
C: Inclusion Criteria:

* Undergoing urogynecologic surgery
* Receive postoperative catheterization

Exclusion Criteria:

* Age less than 21 years old
* Pregnancy
* Allergy, contraindication or intolerance to Nitrofurantoin
* Do not speak English
* Dependent on trans-urethral catheter to accomplish voiding preoperatively
* Undergoing interstim device placement, urethral diverticulum surgery or fistula surgery
* Sustain intraoperative urinary tract injury requiring postoperative catheterization
D: Inclusion Criteria:

* Women who undergo pelvic organ prolapse surgery with a posterior repair
* Age ≥18 years
* Sexually active with heterosexual vaginal intercourse
* English speaking
* Available for 6 month follow up
* Able to complete study questionnaires
* Able to use dilators

Exclusion Criteria:

* Significant baseline dyspareunia
* Pregnancy by self-report or positive pregnancy test
* Prior pelvic radiation therapy
* Active pelvic infection, herpes, candidiasis

Answer: A