Prophylactic acetaminophen does not prevent epidural fever in nulliparous women: a double-blind placebo-controlled trial.
OBJECTIVE
Epidural analgesia is associated with a four- to five- fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus.


METHODS
We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.5 degrees F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%.


RESULTS
In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.4 degrees F was identical in the acetaminophen and placebo groups (23.8%, p=1.0). Neonatal surveillance blood cultures did not reveal occult infection.


CONCLUSIONS
Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.
Goetzl
Laura
L
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
Rivers
Jose
J
Evans
Tracy
T
Citron
Deborah R
DR
Richardson
Barbara E
BE
Lieberman
Ellice
E
Suresh
Maya S
MS
D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D000767:Anesthesia, Epidural; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000517:prevention & control*; D006801:Humans; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010298:Parity; D011247:Pregnancy; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen