Role of intravenous acetaminophen in pediatric anterior cruciate ligament reconstruction

Abstract

BackgroundIntravenous acetaminophen is used as part of a multimodal analgesia regimen for a variety of surgical procedures. In 2015, we implemented a standardized clinical management guideline for patients undergoing anterior cruciate ligament reconstruction. In this study we investigate the clinical impact of intravenous acetaminophen in pediatric patients undergoing arthroscopic anterior cruciate ligament reconstruction managed with and without intravenous acetaminophen. The primary hypothesis of this study was that patients managed with intraoperative intravenous acetaminophen would require less total in-hospital opioid medications. MethodsIn this retrospective cohort study, we compared all patients aged 10 to 21 years of age who underwent arthroscopic anterior cruciate ligament reconstruction at any of the Children's Hospital of Philadelphia locations between December 1, 2015 and November 30, 2017. The patients were grouped based on the administration of an intraoperative dose of intravenous acetaminophen (Group A) or those managed without intraoperative intravenous acetaminophen (Group B). ResultsWe identified 318 patients who underwent an arthroscopic anterior cruciate ligament reconstruction. Patients were similar in age, gender, weight, and duration of surgery. When we grouped the patients based on location of surgery (main hospital vs. ambulatory surgery center), we found that the dose of total in-hospital opioid was not significantly different between the Group A and Group B at the main hospital [difference of mean (95% CI) 0.013 (-0.005, 0.032), p = 0.16); and at the ambulatory surgery center [difference of mean (95% CI) 0.002 (-0.008, 0.011), p = 0.99). ConclusionsIn this cohort, we found that the addition of intravenous acetaminophen to a multimodal pain regimen for anterior cruciate ligament reconstruction surgery is not associated with a reduction in total in-hospital opioid use. This finding may be related to the concomitant use of peripheral nerve blocks and intravenous ketorolac.