Intermittent IV Paracetamol reduces cumulative morphine consumption in Pediatric Cardiac Surgery: Study

Recently published research paper is a multi-center randomized controlled trial that investigated the use of intermittent intravenous (IV) paracetamol as the primary analgesic to reduce morphine consumption in children aged 0–3 years after cardiac surgery with cardiopulmonary bypass. The study aimed to test whether intermittent IV paracetamol administration would result in a reduction of at least 30% of the median weight-adjusted cumulative morphine dose during the first 48 hours after cardiac surgery.

The study found that intermittent IV paracetamol significantly reduced the median weight-adjusted cumulative morphine consumption in the first 48 hours postoperative by 79% compared to continuous morphine. The study, conducted between March 2016 and July 2020, included 208 children aged 0–3 years undergoing cardiac surgery with cardiopulmonary bypass. It found that 102 patients received intermittent IV paracetamol, while 106 received continuous morphine. Additionally, the study showed that the rescue morphine consumption was similar between the two groups. The analysis also demonstrated non-inferiority of IV paracetamol administration in terms of Numeric Rating Scale (NRS) pain scores.

The authors concluded that in children aged 0–3 years undergoing cardiac surgery, the use of intermittent IV paracetamol reduces the median weight-adjusted cumulative morphine consumption in the first 48 hours after surgery by 79%. The study implications suggest that intermittent IV paracetamol as the primary analgesic could be an effective approach for postoperative pain management in this patient population, potentially leading to reduced morphine consumption and equal pain relief.

Overall, the research paper provides evidence for the potential benefits of using intermittent IV paracetamol as a primary analgesic to reduce morphine consumption in young children after cardiac surgery with cardiopulmonary bypass. The findings have implications for clinical practice in managing postoperative pain in this specific patient population.

The study was approved by the relevant medical ethics committees and registered in clinical trial registries. The data used in the study are available, and the study was funded by relevant health research and development organizations. The authors declared no competing interests in the study.

The paper provides detailed insights into the methodology, patient characteristics, outcomes, statistical analysis, and implications of the study. The findings have significant implications for postoperative pain management in young children undergoing cardiac surgery with cardiopulmonary bypass.

Key Points

1. The study included 208 children and found that intermittent IV paracetamol significantly reduced the median weight-adjusted cumulative morphine consumption in the first 48 hours postoperative by 79% compared to continuous morphine. Additionally, the rescue morphine consumption was similar between the two groups, and the analysis demonstrated non-inferiority of IV paracetamol administration in terms of Numeric Rating Scale (NRS) pain scores.

2. The authors concluded that the use of intermittent IV paracetamol reduces the median weight-adjusted cumulative morphine consumption in the first 48 hours after surgery by 79% in young children undergoing cardiac surgery. They suggest that intermittent IV paracetamol as the primary analgesic could be an effective approach for postoperative pain management in this patient population, potentially leading to reduced morphine consumption and equal pain relief. This study has potential implications for clinical practice in managing postoperative pain in young children undergoing cardiac surgery with cardiopulmonary bypass.

Reference -

Zeilmaker-Roest, G., de Vries-Rink, C., van Rosmalen, J. et al. Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial. Crit Care 28, 143 (2024). https://doi.org/10.1186/s13054-024-04905-3