IV Acetaminophen Prior to IV Opioids Reduces duration of Opioids use in Children

The importance and frequency of clinical opioid adverse effects and increased hospital length of stay have led to attempts to reduce opioid use. Intravenous (IV) acetaminophen has been a common analgesic initiated before opioids in multimodal pain regimens to reduce subsequent opioid requirements. However, assessments of the association between IV acetaminophen and opioid use in multimodal pain regimens have had conflicting results. Therefore, Dr Anita K. Patel and her team conducted a study to determine if IV acetaminophen administered prior to IV opioids is associated with a reduction in the total duration of IV opioids administered compared with IV opioids administered without IV acetaminophen in general pediatric inpatients.

In a comparative effectiveness study, the researchers included 104 579 pediatric inpatients from 274 US hospitals. They compared the outcomes with a propensity score-matched analysis of pediatric inpatients administered IV opioids without IV acetaminophen (control) and that administered IV acetaminophen prior to IV opioids (intervention). The major outcome assessed was the total duration of all IV opioids administered during a patient's hospitalization.

Key findings of the study:

• Among patients who received IV acetaminophen, 1739 (10.8%) received IV acetaminophen prior to IV opioids within a median (IQR) treatment time of 1.5 hours.
• After propensity score matching produced comparable groups in the control and intervention groups (with 839 patients in each group), using the multivariable model, the researchers found that IV acetaminophen administered prior to IV opioids was associated with a 15.5%, or 7.5-hour, reduction in total IV opioid duration.

The authors concluded, " In this comparative effectiveness study, IV acetaminophen administered prior to IV opioids was associated with a reduction in IV opioid duration by 15.5%. Multimodal pain regimens that use IV acetaminophen prior to IV opioids could reduce IV opioid duration."

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DOI: 10.1001/jamanetworkopen.2021.38420