Single-Dose IV Acetaminophen Doesn’t Reduce PACU Analgesic Need

April 21, 2017

Single-dose IV acetaminophen did not offer significant benefit to children undergoing outpatient ENT (ear, nose and throat) procedures, as measured by the administration of PACU analgesia, particularly opioids.  “We know that pain after surgery is very common no matter what we do, in a wide variety of surgical procedures,” said Olubukola Nafiu, MD, associate professor of pediatrics and anesthesiology at University of Michigan Medical School, in Ann Arbor. “We also know that poorly managed perioperative pain can have long-term consequences.”  Dr. Nafiu and his colleagues enrolled 229 children (aged 4-17 years) into the prospective, observational study. Each participant underwent an elective, ambulatory ENT procedure; 102 participants (44.5%) received intraoperative IV acetaminophen, whereas the remaining 127 did not. 43.7% of patients required analgesic intervention in the PACU, while 34.9% received IV opioid. Of note, patients who received IV acetaminophen had significantly higher rates of intraoperative opioid use (98.0%) than those who did not receive the study agent (82.7%; P<0.001). Nevertheless, intraoperative morphine equivalents were comparable between groups (IV acetaminophen 0.11±0.05/kg vs. no IV acetaminophen 0.09±0.12/kg; P=0.14).    “A number of studies that have shown efficacy for IV acetaminophen have looked at multiple doses of the drug, particularly in patients undergoing orthopedic procedures,” Dr. Nafiu said. “When single-dose IV acetaminophen has been studied, the results have been similar to what we found.  In the current climate of value-based health care, studies such as these are very timely and needed,” he added.