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Use of Intravenous Acetaminophen in Children for Analgesia After Spinal Fusion Surgery: A Randomized Clinical Trial

Nicole Rizkalla, Nicole R Zane, Janice L Prodell

    The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
    |November 16, 2018
    PubMed

    Insights

    Intravenous acetaminophen in children undergoing spine surgery reduced opioid use and advanced diet progression. This non-opioid analgesic offers a safer alternative for postoperative pain management.

    Area of Science:

    • Pediatric Anesthesiology
    • Pain Management
    • Surgical Outcomes

    Background:

    • Opioid analgesics are standard for postoperative pain but carry risks.
    • Multimodal analgesia using non-opioid agents is optimal for pediatric surgical patients.
    • Intravenous (IV) acetaminophen presents a potential non-opioid option.

    Purpose of the Study:

    • To evaluate the efficacy of IV acetaminophen in reducing opioid requirements post-spine surgery in children.
    • To assess the impact of IV acetaminophen on clinical outcomes, including diet advancement and analgesic discontinuation.

    Main Methods:

    • A single-center, randomized, double-blind study involving 57 pediatric patients (10-18 years) undergoing posterior spine fusion.
    • Patients received either IV acetaminophen or placebo post-surgery, with repeated doses every 6 hours for 8 doses.

    Main Results:

    • The IV acetaminophen group showed significantly lower opioid consumption in the first 24 hours (p=0.02).
    • Time to first solid intake was significantly shorter in the acetaminophen group (49 hours vs. 69 hours, p=0.01).
    • While unadjusted time to patient-controlled analgesia (PCA) discontinuation was longer in the placebo group, it was not significant after weight normalization.

    Conclusions:

    • Postoperative IV acetaminophen use is linked to earlier diet advancement and IV analgesic discontinuation in pediatric spine surgery patients.
    • This non-opioid analgesic may contribute to reduced overall opioid consumption.
    • IV acetaminophen is a viable component of multimodal analgesia for pediatric surgical patients.
    Abstract

    Keywords:
    acetaminophenanalgesiapediatricpostoperative pain

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