Reduced Postoperative Opioid Administration in Infants With Standing IV Acetaminophen Protocol

A standing intravenous (IV) acetaminophen protocol is associated with decreased postoperative opioid administration in infants without increasing pain scores. These findings were published in the Journal of Surgical Research.

All infants (N=131) treated on the acute care floor who underwent abdominal or anorectal surgery between 2012 and 2020 at University of Virginia School of Medicine were included in this study. In 2016, an opioid-reduction quality improvement initiative was launched. The intervention included standing IV acetaminophen every 6 hours for at least 48 hours after surgery, dosed at 12.5 to 15 mg/kg with a maximum dose of 50 to 60 mg/kg/d, depending on age. Opioid consumption and pain outcomes were evaluated prior to the opioid reduction initiative (n=56) and compared with patient data prospectively collected during the program roll-out (n=17) and after its launch (n=58).

The preintervention, roll-out, and postintervention cohorts were aged mean 36.6±3.8, 38.1±3.7, and 37.3±2.5 weeks’ gestation at birth; they underwent surgery at 183±102, 174±106, and 156±89 days of life; 51.8%, 64.7%, and 46.5% were girls; and 23.2%, 17.6%, and 15.5% had cardiac anomalies, respectively.

Compared with the preintervention cohort, the roll-out and postintervention cohorts were administered fewer morphine equivalents after surgery (median, 0.36 vs 0.0 vs 0.0 mg/kg; P <.0001), fewer received postoperative opioid infusion (10.7% vs 0.0% vs 1.7%; P =.046), and more patients received no postoperative morphine (8.9% vs 58.8% vs 55.2%; P <.0001), respectively.

Despite differences in opioid administration, face, legs, activity, cry, and consolability (FLACC) pain scale scores did not differ during the first 24 hours (P =.558), second 24 hours (P =.584), or first 48 hours (P =.197) after surgery.

The preintervention cohort was associated with longer postoperative length of hospital stay (median, 5 vs 3 vs 3 days; P <.0001) and total length of stay (median, 7 vs 4 vs 4 days; P <.0001).

After the intervention was launched no trends in mortality or surgical outcomes were observed.

The major limitation of this study was possible investigator bias, given that the investigators had an inherent interest in reducing postoperative opioid administration among infants.

“The implementation of standing IV acetaminophen is associated with a reduction in postoperative opioid use in infants being treated on the acute care floor while maintaining equivalent FLACC pain scores,” the study authors wrote. “Given the negative clinical effects opiate use can have in postoperative infants, similar opiate reduction strategies may be of value in various departments and at other institutions.”

Reference

Vavolizza RD, Grabski DF, Roecker Z,et al. Standing intravenous acetaminophen Is associated with a reduction of postoperative opioid use in infants aged less than 1 year treated on the acute care floor. J Surg Res. Published online April 9, 2022. doi:10.1016/j.jss.2022.02.051