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Does intravenous acetaminophen reduce perioperative opioid use in pediatric tonsillectomy?
Am J Otolaryngol 2019; :102294AJ

Abstract

OBJECTIVE

Postoperative pain control is of significant interest in pediatric otolaryngology given the safety concerns with opioid use. We sought to determine if addition of intraoperative intravenous acetaminophen decreases perioperative morphine use in pediatric tonsillectomy.

METHODS

This study is a retrospective cohort study performed at a tertiary care academic children's hospital. 166 pediatric patients (aged 1-16 years) who underwent tonsillectomy with or without adenoidectomy were for review. Seventy-four patients received intraoperative intravenous acetaminophen (intervention cohort), while ninety-two patients served as our control and did not receive any intraoperative intravenous acetaminophen. Perioperative (intraoperative and postoperative) morphine use was our primary outcome measure. Rate of adverse events in the post anesthesia care unit and time for discharge readiness were secondary outcome measures. Wilcoxon two-sample t-test approximation and Fisher's exact test were used for data analyses.

RESULTS

Patients in the intravenous acetaminophen cohort received less morphine (mg/kg) intraoperatively (0.058 versus 0.070, p = 0.089) and in the post anesthesia care unit (0.034 versus 0.051, p = 0.034) than the control cohort. The median time to discharge readiness for the intravenous acetaminophen and control groups was 108.5 versus 105 min (p = 0.018). There was no adverse respiratory event (oxygen desaturation <92% lasting more than a minute, requiring bag mask ventilation or reintubation) in either group in the post anesthesia care unit. There were 5 (7%) episodes of postoperative vomiting in the IV APAP, while 2 (2%) were recorded in the control cohort (p = 0.244).

CONCLUSION

Our findings suggest intraoperative intravenous acetaminophen use in pediatric tonsillectomy can decrease the perioperative use of opioid for optimal pain management.

Authors+Show Affiliations

Department of Otolaryngology, Cook Children's Hospital, 901 7th Avenue, 1st Floor, Fort Worth, TX 76104, United States of America.Scope Anesthesia, Carolinas Medical Center/Levine Children's Hospital, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.Department of Mathematics and Statistics, University of West Florida, 11000 University Parkway, Pensacola, FL 32514, United States of America.Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America. Electronic address: jcarron@umc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31521403

Citation

Chisholm, Allison G., et al. "Does Intravenous Acetaminophen Reduce Perioperative Opioid Use in Pediatric Tonsillectomy?" American Journal of Otolaryngology, 2019, p. 102294.
Chisholm AG, Sathyamoorthy M, Seals SR, et al. Does intravenous acetaminophen reduce perioperative opioid use in pediatric tonsillectomy? Am J Otolaryngol. 2019.
Chisholm, A. G., Sathyamoorthy, M., Seals, S. R., & Carron, J. D. (2019). Does intravenous acetaminophen reduce perioperative opioid use in pediatric tonsillectomy? American Journal of Otolaryngology, p. 102294. doi:10.1016/j.amjoto.2019.102294.
Chisholm AG, et al. Does Intravenous Acetaminophen Reduce Perioperative Opioid Use in Pediatric Tonsillectomy. Am J Otolaryngol. 2019 Sep 9;102294. PubMed PMID: 31521403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does intravenous acetaminophen reduce perioperative opioid use in pediatric tonsillectomy? AU - Chisholm,Allison G, AU - Sathyamoorthy,Madhankumar, AU - Seals,Samantha R, AU - Carron,Jeffrey D, Y1 - 2019/09/09/ PY - 2019/08/29/received PY - 2019/09/09/accepted PY - 2019/9/16/entrez PY - 2019/9/16/pubmed PY - 2019/9/16/medline KW - Acetaminophen KW - Morphine KW - Pain KW - Pediatric KW - Postoperative KW - Tonsillectomy SP - 102294 EP - 102294 JF - American journal of otolaryngology JO - Am J Otolaryngol N2 - OBJECTIVE: Postoperative pain control is of significant interest in pediatric otolaryngology given the safety concerns with opioid use. We sought to determine if addition of intraoperative intravenous acetaminophen decreases perioperative morphine use in pediatric tonsillectomy. METHODS: This study is a retrospective cohort study performed at a tertiary care academic children's hospital. 166 pediatric patients (aged 1-16 years) who underwent tonsillectomy with or without adenoidectomy were for review. Seventy-four patients received intraoperative intravenous acetaminophen (intervention cohort), while ninety-two patients served as our control and did not receive any intraoperative intravenous acetaminophen. Perioperative (intraoperative and postoperative) morphine use was our primary outcome measure. Rate of adverse events in the post anesthesia care unit and time for discharge readiness were secondary outcome measures. Wilcoxon two-sample t-test approximation and Fisher's exact test were used for data analyses. RESULTS: Patients in the intravenous acetaminophen cohort received less morphine (mg/kg) intraoperatively (0.058 versus 0.070, p = 0.089) and in the post anesthesia care unit (0.034 versus 0.051, p = 0.034) than the control cohort. The median time to discharge readiness for the intravenous acetaminophen and control groups was 108.5 versus 105 min (p = 0.018). There was no adverse respiratory event (oxygen desaturation <92% lasting more than a minute, requiring bag mask ventilation or reintubation) in either group in the post anesthesia care unit. There were 5 (7%) episodes of postoperative vomiting in the IV APAP, while 2 (2%) were recorded in the control cohort (p = 0.244). CONCLUSION: Our findings suggest intraoperative intravenous acetaminophen use in pediatric tonsillectomy can decrease the perioperative use of opioid for optimal pain management. SN - 1532-818X UR - https://www.unboundmedicine.com/medline/citation/31521403/Does_intravenous_acetaminophen_reduce_perioperative_opioid_use_in_pediatric_tonsillectomy L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0709(19)30810-5 DB - PRIME DP - Unbound Medicine ER -