Purpose: Adenotonsillectomyis one of the most common procedures performed in children. Perioperative pain management in this surgical population is challenging due to obstructive sleep apnea and other comorbidities. As a result, multimodal analgesia is increasingly advocated. Acetaminophen and nonsteroidal anti- inflammatory drugs are the most popular drugs used as part of multimodal analgesia. The purpose of this study is to examine the impact of intraoperative administration of intravenous acetaminophen on opioid use pattern during the perioperative period in children undergoing adenotonsillectomy.
Methods: This is a retrospective study of prospectively collected data from electronic medical records. We reviewed the patient demographics, morphine use during the intraoperative and immediate postoperative period, pain scores, and need for rescue analgesics in the post-anesthesia care unit (PACU). The dose of Intravenous Acetaminophen used in the study was 15 mg/kg. Acetaminophen was administered by infusion over a period of 15 minutes. Case control matching between the morphine-only and intravenous acetaminophen groups was performed before analysis.
Results: After matching, we had 91 patients in both the morphine-only and intravenous acetaminophen groups. The intravenous acetaminophen group received significantly less morphine during the intraoperative period. However, this same group needed significantly more morphine in the PACU. Interestingly at the time of discharge, there was no difference in the total amount of morphine used between two groups. In addition, there was no significant difference in pain scores between the groups.
Conclusion: Intraoperative administration of Intravenous acetaminophen does not decrease the amount of morphine used during the immediate perioperative period in children undergoing adenotonsillectomy. Our results question the usefulness of timing of administration of intravenous acetaminophen as a part of multimodal analgesia in our surgical population.
Keywords: Intraoperative pain management, post operative pain management, intravenous acetaminophen, multimodal analgesia, adenotonsillectomy