Effect of Intravenous Paracetamol on Postoperative Morphine Requirements in Neonates and Infants Undergoing Major Noncardiac Surgery

Abstract

trialregister.nl Identifier: NTR1438.

Double-Blind Randomized Placebo-Controlled Trial of Single-Dose Intravenous Acetaminophen for Pain Associated With Adenotonsillectomy in Pediatric Patients With Sleep-Disordered Breathing

“…Although multiple studies [18][19][20] have shown an opioid-sparing effect or enhanced analgesic efficacy of intravenous acetaminophen in the adult and pediatric population for various surgical procedures, a similar effect was not seen in our study cohort. One explanation is that our usual analgesic regimen for such patients included an intraoperative dose of morphine (0.1 mg/kg), which was adequate for many of the patients, thereby mitigating the ability to see any additional effect from a single intraoperative dose of a non-opioid analgesic.…”

“…We found no significant differences with regard to PACU stay or hospitalization duration to justify the drug cost, which has been previously reported. 19 In conclusion, a single dose of intraoperative intravenous acetaminophen when combined with morphine in a dose of 0.1 mg/kg and dexamethasone provided no added analgesic or recovery benefit in pediatric patients aged 2 to 8 years with SDB undergoing adenotonsillectomy.…”

Prevention and Management of Procedural Pain in the Neonate: An Update

“…Although intravenous acetaminophen has not been approved by the US Food and Drug Administration, preliminary data on its safety and efficacy are promising in neonates and infants and it may decrease the total amount of morphine needed to treat postoperative pain. [107][108][109] Nonsteroidal antiinflammatory medication use has been restricted to pharmacologic closure of patent ductus arteriosus because of concerns regarding renal insufficiency, platelet dysfunction, and the development of pulmonary hypertension. 110 An animal study suggests that cyclooxygenase-1 inhibitors are less effective in immature compared with mature animals, probably because of decreased cyclooxygenase-1 receptor expression in the spinal cord.…”

Use of Intravenous Ketorolac as Postoperative Analgesic in Neonates: A Prospective Study in Chittagong, Bangladesh

“…However during subsequent days there was no significant difference between the groups. A randomized, double-blind study was done by Ceelie et al (2013) also noticed higher prevalence of bleeding tendency in postoperative day with ketorolac 30 . Although there was skepticism about use of ketorolac from the fear of renal compromise, it is now becoming analgesic of choice for use in neonates after major surgeries [31][32] .…”