Does intravenous acetaminophen reduce perioperative opioid use in pediatric tonsillectomy?
Author links open overlay panelAllison G.ChisholmaMadhankumarSathyamoorthybSamantha R.SealscJeffrey D.Carrond
a
Department of Otolaryngology, Cook Children's Hospital, 901 7th Avenue, 1st Floor, Fort Worth, TX 76104, United States of America
b
Scope Anesthesia, Carolinas Medical Center/Levine Children's Hospital, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America
c
Department of Mathematics and Statistics, University of West Florida, 11000 University Parkway, Pensacola, FL 32514, United States of America
d
Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America
Received 29 August 2019, Available online 9 September 2019.
Show less
https://doi.org/10.1016/j.amjoto.2019.102294Get rights and content
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.
Keywords
TonsillectomyAcetaminophenPostoperativePainMorphinePediatric
View full text
© 2019 Published by Elsevier Inc.
Author links open overlay panelAllison G.ChisholmaMadhankumarSathyamoorthybSamantha R.SealscJeffrey D.Carrond
a
Department of Otolaryngology, Cook Children's Hospital, 901 7th Avenue, 1st Floor, Fort Worth, TX 76104, United States of America
b
Scope Anesthesia, Carolinas Medical Center/Levine Children's Hospital, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America
c
Department of Mathematics and Statistics, University of West Florida, 11000 University Parkway, Pensacola, FL 32514, United States of America
d
Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America
Received 29 August 2019, Available online 9 September 2019.
Show less
https://doi.org/10.1016/j.amjoto.2019.102294Get rights and content
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.
Keywords
TonsillectomyAcetaminophenPostoperativePainMorphinePediatric
View full text
© 2019 Published by Elsevier Inc.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου