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Updated: Jun 29, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Improving perioperative acetaminophen administration for safer and cost-effective multimodal analgesia in pediatric
Richard M Mahon1, Prabi Rajbhandari1, Todd A Brown1
1Akron Children's Hospital, Akron, Ohio, USA.
Insights
This study enhanced pediatric perioperative pain management by increasing acetaminophen use, improving pain scores and reducing opioid reliance. Safe and effective analgesia was achieved through targeted interventions.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Quality Improvement
Background:
- Acetaminophen offers a safer, cost-effective analgesia option in pediatric perioperative care.
- Current use of perioperative acetaminophen in pediatric surgical patients is suboptimal.
Purpose of the Study:
- To increase the use of oral and intravenous acetaminophen in the perioperative period for pediatric surgical patients.
- To improve the utilization of enteral acetaminophen administration.
Main Methods:
- A multidisciplinary team employed a quality improvement (QI) methodology.
- Interventions included education, enhanced acetaminophen availability, and EMR optimization.
- Data on acetaminophen use, pain scores, and opioid consumption were tracked via automated EMR reports.
Main Results:
- Perioperative acetaminophen use increased from 39.5% to 63% within 24 months, exceeding the 50% goal.
- Oral acetaminophen usage rose from 10% to 78%.
- Average maximum PACU pain scores decreased from 5.4 to 5.2, and opioid use reduced from 15.4% to 13.1%.
Conclusions:
- Achieved and sustained significant improvements in perioperative acetaminophen use for pediatric surgical patients.
- Enhanced acetaminophen utilization did not worsen pain scores or opioid consumption.
- Future efforts will focus on further optimizing pediatric perioperative pain management strategies.
Background:
The use of acetaminophen in the perioperative period has emerged as an attractive option for providing safer and cost-effective analgesia in children.
Aims:
The primary aim of our project was to increase the use of acetaminophen (both oral and intravenous) in the perioperative period from a baseline of 39.5% to 50% for all surgical patients within 24 months. The secondary aim was to increase the use of enteral acetaminophen from 10% to 52.5% during the same period.
Methods:
A multidisciplinary team was formed, and model for improvement was chosen as the QI methodology. The primary measure was the total percentage of surgical patients receiving any form of perioperative acetaminophen, while our secondary measure was the percentage use of oral acetaminophen administration. We also tracked the average maximum PACU (Post Anesthesia Care Unit) pain scores and the percentage of patients receiving IV opioids. Multiple interventions were conducted, including education, increasing the availability of acetaminophen, and optimizing the electronic medical record (EMR). Monthly data was collected using an automated report in the EMR.
Results:
We successfully achieved our goal, increasing the use of acetaminophen from 39.5% to 70% within four months. Despite some fluctuations, by the end of 24 months, we not only met but surpassed our goal, with 63% of patients receiving perioperative acetaminophen. Similarly, the usage of oral acetaminophen increased from a baseline of 10% to 78%. Our average maximum PACU pain scores improved from 5.4 to 5.2, and the percentage of patients receiving rescue opioids decreased from 15.4 to 13.1.
Conclusion:
We successfully achieved and sustained our goals of improving acetaminophen use for our surgical patients without worsening pain scores or worsening use of intravenous opioids. Future directions include further refining our strategies and exploring additional opportunities to optimize pain management in pediatric perioperative settings.
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