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Effect of Intraoperative Intravenous Acetaminophen Administration on Opioid Requirements in Children Undergoing

Lohit Velagapudi1, Christy J Crockett2, Amy X Zhang3

  • 1Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Vanderbilt University School of Medicine.

The Journal of Craniofacial Surgery
|August 6, 2026
PubMed

Insights

Intravenous acetaminophen (IVAPAP) reduced postoperative oxycodone use in pediatric complex cranial vault reconstruction (CCVR). Further research is needed to confirm these findings for craniosynostosis repair.

Area of Science:

  • Pediatric Anesthesiology
  • Craniofacial Surgery
  • Pain Management

Background:

  • Complex cranial vault reconstruction (CCVR) for craniosynostosis necessitates substantial analgesia.
  • Intravenous acetaminophen (IVAPAP) effectively lowers opioid needs in other pediatric surgeries.
  • The role of IVAPAP in CCVR pain management remains unconfirmed.

Purpose of the Study:

  • To evaluate the impact of intraoperative IVAPAP on perioperative opioid consumption in pediatric CCVR.
  • To assess the efficacy of IVAPAP in reducing opioid requirements for craniosynostosis surgery.

Main Methods:

  • Retrospective analysis of pediatric patients (≤12 years) undergoing CCVR.
  • Comparison between cohorts receiving intraoperative IVAPAP and those who did not.
  • Exclusion of patients receiving other intraoperative IV non-opioid analgesics; opioid requirements measured as IV morphine equivalents.

Main Results:

  • IVAPAP group showed significantly lower postoperative oxycodone requirements.
  • No significant differences observed in intraoperative opioid needs or total 24-hour opioid consumption.
  • Demographics were comparable between the IVAPAP and non-IVAPAP cohorts.

Conclusions:

  • Intraoperative IVAPAP administration is linked to decreased postoperative oxycodone use.
  • The findings suggest IVAPAP may be a valuable component of multimodal analgesia for CCVR.
  • A prospective randomized controlled trial is recommended to validate these results.
Abstract

Keywords:
Acetaminophencraniosynostosesnonopioid analgesicspain management

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