Association of Intravenous Acetaminophen Administration With the Duration of Intravenous Opioid Use Among Hospitalized Pediatric Patients

Anita K Patel,James E Bost,Eduardo Trujillo-Rivera,Jiaxiang Gai,Farhana Faruqe,Dongkyu Kim,Murray M Pollack

doi:10.1001/jamanetworkopen.2021.38420

Anita K Patel, James E Bost + Show 5 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2021.38420

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Abstract

Adoption of multimodal pain regimens that incorporate nonopioid analgesic medications to reduce inpatient opioid administration can prevent serious opioid-related adverse 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 general pediatric inpatients. 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. This comparative effectiveness research study included data on pediatric inpatients from 274 US hospitals between January 2011 and June 2016 collected from a national database. Outcomes were compared with a propensity score-matched analysis of pediatric inpatients administered IV opioids without IV acetaminophen (control) and those administered IV acetaminophen prior to IV opioids (intervention). Data were analyzed from January 2020 through October 2021. Patients in the intervention group received IV acetaminophen prior to IV opioids. Patients in the control group received IV opioids without IV acetaminophen. Total duration of all IV opioids administered during a patient's hospitalization. Of 893 293 pediatric inpatients, a total of 104 579 were included in analysis (median [IQR] age, 1.3 [0-14.7] years; 59 806 [57.2%] female; 21 485 [21.5%] African American, 56 309 [53.8%] White), of whom 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, 1739 (10.8%) received IV acetaminophen prior to IV opioids within a median (IQR) treatment time of 1.5 (0.02-7.3) hours. After propensity score matching produced comparable groups in the control and intervention groups (with 839 patients in each group), the multivariable model estimated a 15.5% shorter duration of IV opioid use in the intervention group, with an absolute IV opioid reduction of 7.5 hours (95% CI, 0.7-15.8 hours). 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.

Highlights

Opioid medications are a common therapeutic approach to alleviate pain in pediatric inpatients
In this comparative effectiveness study, IV acetaminophen administered prior to IV opioids was associated with a reduction in IV opioid duration by 15.5%
The aim of this analysis was to determine if the initiation of IV acetaminophen prior to IV opioids would result in a reduction in the total hospital duration of IV opioid use compared with IV opioid medications administered without IV acetaminophen in both operative and nonoperative pediatric inpatients in a national database

Summary

Introduction

Opioid medications are a common therapeutic approach to alleviate pain in pediatric inpatients. A prominent therapeutic approach uses multiple medications, most notably a nonopioid analgesic medication (with opioids reserved as second-line analgesic medications).[10,11,12] Intravenous (IV) acetaminophen has been a common analgesic initiated prior to opioids in multimodal pain regimens with the purpose of reducing subsequent opioid requirements.[13,14,15,16] assessments of the association between IV acetaminophen and opioid use in multimodal pain regimens have had conflicting results.[13,14,15,17,18,19,20,21] In particular, randomized studies that compare treatment that initiates pain control with IV acetaminophen and supplements with opioids vs therapy initiated with opioids have been small with conflicting results.[13,18,19,22] The aim of this analysis was to determine if the initiation of IV acetaminophen prior to IV opioids would result in a reduction in the total hospital duration of IV opioid use compared with IV opioid medications administered without IV acetaminophen in both operative and nonoperative pediatric inpatients in a national database This analysis used a national database and propensity score matching

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