Anita Patel, MD
Assistant Professor of Pediatrics
Childrens National Medical Center
Washington, District of Columbia, United States
Disclosure information not submitted.
Jiaxiang Gai, PhD
Assistant Professor of Pediatrics
Childrens National Medical Center, United States
Disclosure information not submitted.
Eduardo Trujillo-Rivera, PHd
Assistant Professor of Bioinformatics
George Washington School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Farhana Faruqe, MS
Clinical Instructor
Children's National Medical Center, United States
Disclosure information not submitted.
Dongkyu Kim, PhD
Assistant Professor of Pediatrics
Children's National Medical Center, United States
Disclosure information not submitted.
James Bost, PHd
Associate Professor of Pediatrics
Children's National Health System
Washington, District of Columbia, United States
Disclosure information not submitted.
Murray Pollack, MBA, MD, MCCM
M.D.
Childrens National Health Systems, United States
Disclosure information not submitted.
Title:The Association of IV Acetaminophen with the Duration of IV Opioid Use in Pediatric Inpatients
Importance: Adoption of multimodal pain regimens that incorporate non-opioid analgesic medications to reduce inpatient opioid administration can prevent serious opioid-related side effects in children, including: tolerance, withdrawal, delirium, and respiratory depression. Intravenous (IV) acetaminophen is in widespread pediatric use; however, its effectiveness as an opioid sparing agent has not been evaluated in a general pediatric inpatient population. The aim of this study was to determine if IV acetaminophen administered prior to IV opioids results in a reduction in the total duration of IV opioids administered compared to IV opioids administered without IV acetaminophen in general pediatric inpatient populations.
Methods: A propensity score matched analysis of pediatric inpatients prescribed IV opioids without IV acetaminophen (control) and those prescribed IV acetaminophen prior to IV opioids (intervention) from January 2011 to June 2016 using the national, multi-center database, Health Facts®. The outcome was total duration of all IV opioids administered during a patient’s hospitalization.
Results: Of 893,293 pediatric inpatients, 18,197 (2.0%) received IV acetaminophen, and 287,504 (34.0%) received IV opioids. After applying exclusion criteria, among patients who received IV acetaminophen, 10.8% (n = 1,739) received IV acetaminophen prior to IV opioids within a median of 1.5 hours (IQR 0.02-7.3 hours). After propensity score matching, patients in the intervention group had a median (IQR) IV opioid duration of 27.7 hours (4.0-76.1) compared to 33.5 hours (5.4-74.0 hours, p = 0.405). Propensity score matching produced comparable groups in the control and intervention groups (n = 839 in each group). The multivariable model estimated a 17.0% shorter duration of IV opioid use in the intervention group (p < 0.001).
Conclusion: In this comparative effectiveness study, IV acetaminophen administered prior to IV opioids was associated with a reduction in IV opioid duration by 17.0%. Multi-modal pain regimens that use IV acetaminophen prior to IV opioids are, in general, expected to reduce IV opioid duration.