IV Paracetamol Reduces Morphine Use in Young Children Post-Cardiac Surgery, reveals research

Morphine has traditionally been used for pain management in children undergoing cardiac surgery, but it comes with risks such as respiratory depression. Paracetamol is a potential alternative to reduce these risks while still providing effective pain management.

The study included 194 patients aged 0-3 years who underwent cardiac surgery with cardiopulmonary bypass between March 2016 and July 2020. Patients were randomized to either continuous morphine or intermittent IV paracetamol as the primary analgesic after receiving a loading dose of 100 mcg/kg of morphine at the end of surgery. Rescue morphine was administered if numeric rating scale (NRS) pain scores exceeded a predetermined threshold.

The primary outcome was the median weight-adjusted cumulative morphine dose (mcg/kg) in the first 48 hours post-surgery. The study used the nonparametric Van Elteren test, stratified by center, for primary outcome comparison.

The key findings of the study were:

• The IV paracetamol group had a median weight-adjusted cumulative morphine dose of 145.0 mcg/kg (IQR 115.0-432.5 mcg/kg) compared to 692.6 mcg/kg (IQR 532.7-856.1 mcg/kg) in the continuous morphine group.

• This represents a 79% reduction in morphine use (P < 0.001).

• Both groups showed similar rescue morphine consumption (P = 0.38) and similar levels of pain relief, suggesting non-inferiority of IV paracetamol administration in terms of NRS pain scores.

• The non-inferiority analysis revealed a difference in proportion of patients with NRS pain scores of 4 or higher between the groups at -3.1% (95% CI -16.6-10.3%).

These findings suggest that IV paracetamol is an effective primary analgesic option for children aged 0-3 years post-cardiac surgery, offering significant reductions in morphine use without compromising pain relief. This could be a safer and potentially more efficient approach to post-surgical pain management.

The use of intermittent IV paracetamol as the primary analgesic in children aged 0-3 years after cardiac surgery with cardiopulmonary bypass results in a significant 79% reduction in median weight-adjusted cumulative morphine consumption over the first 48 hours post-surgery. The findings suggest that IV paracetamol provides equal pain relief compared to continuous morphine, indicating its potential as a safer and effective primary analgesic option for young children post-cardiac surgery.

Reference:

Zeilmaker-Roest, G., de Vries-Rink, C., van Rosmalen, J., van Dijk, M., de Wildt, S. N., Knibbe, C. A. J., Koomen, E., Jansen, N. J. G., Kneyber, M. C. J., Maebe, S., Van den Berghe, G., Haghedooren, R., Vlasselaers, D., Bogers, A. J. J. C., Tibboel, D., & Wildschut, E. D. (2024). Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial. Critical Care (London, England), 28(1). https://doi.org/10.1186/s13054-024-04905-3