Title: Intravenous Acetaminophen: A study of effectiveness of practice of intraoperative administration in children undergoing adenotonsillectomy.
Adenotonsillectomy is one of the most common procedures performed in children
Perioperative pain management is challenging due to concomitant presence of Obstructive Sleep Apnea (OSA) in this patient population
In our practice, Morphine is used primarily for analgesia. In addition, we use IV Acetaminophen and Toradol for opioid sparing
The objective of the study is to examine the impact of intraoperative administration of intravenous acetaminophen on opioid use pattern during the perioperative period in children undergoing adenotonsillectomy
This was a retrospective study and data was collected from electronic medical record after an IRB approval
The inclusion criteria of study was children less than 10 years of age who had adenotonsillectomy and morphine only as an opioid in perioperative period
The exclusion criteria was children over 50 kgs, use of Dexmedetomidine, Total tonsillectomy, BMT with adenotonsillectomy, ASA class III & IV and use of opioid other than Morphine
Based on medical record review patients we divided patients into two groups depending on whether they received intravenous acetaminophen during the intraoperative period
Amount of morphine received during the surgery, in PACU and total at the time of discharge were calculated
Case control matching estimating common odds ratio utilizing the Mantel-Haenszel test was achieved using age, weight, gender, and presence of OSA as covariates. Student’s t-test was used for continuous variables with significance at 95% confidence interval (CI).
Case control matching yielded 91 patients in each group and there were no differences in age, weight, gender and incidence of OSA between groups
IV Acetaminophen group received significantly less intraoperative morphine compared with control group
However, IV Acetaminophen group received more morphine in the PACU
Neither the total morphine nor the total morphine per kilogram received in the operating room and the PACU combined was statistically different
The percentage of patients receiving rescue doses of opioid in the PACU and pain scores was not statistically significant between the two groups
Administration of intraoperative intravenous acetaminophen doesn’t decrease the amount of morphine administered at the time of discharge
Intraoperative Acetaminophen doesn’t decrease the pain scores in PACU nor the length of stay
We speculate that timing of intravenous acetaminophen in the PACU for break through pain may be a better practice than intraoperative administration
Administration of IV Acetaminophen in the PACU may limit the amount of opioid administered in the PACU
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