title: Fentanyl-sparing effect of acetaminophen as a mixture of fentanyl in intravenous parent-/nurse-controlled analgesia after pediatric ureteroneocystostomy.
abstract: BACKGROUND
  Although acetaminophen has been used widely and is well tolerated in children, its efficacy and safety have not been clarified when combined with an opioid in intravenous parent-/nurse-controlled postoperative analgesia.
  
  
  METHODS
  Sixty-three children (aged 6-24 months) who had undergone elective ureteroneocystostomies were enrolled in this prospective, randomized, double-blinded study. After the surgery, an analgesic pump was programmed to deliver fentanyl at a basal infusion rate of 0.25 microg.kg(-1).h(-1) and 0.25 microg/kg bolus after a loading dose of 0.5 microg/kg(-1). In the fentanyl-acetaminophen group, acetaminophen was coadministered as a solution mixture at a basal infusion rate of 1.5 mg.kg(-1).h(-1) and 1.5 mg/kg bolus after a loading dose of 15 mg/kg, whereas saline was administered to the fentanyl group.
  
  
  RESULTS
  Postoperative pain scores were similar between the two groups. The total dose (micrograms per kilogram per day, mean+/-SD) of fentanyl at postoperative days 1 (8.3+/-3.7 vs. 18.1+/-4.6, P=0.021) and 2 (7.0+/-2.4 vs. 16.6, P=0.042) was significantly less in the fentanyl-acetaminophen group compared with that in the fentanyl group. The incidences of vomiting (16.1 vs. 56.3%, P=0.011) and sedation (9.7 vs. 46.9%, P=0.019) were significantly lower in the fentanyl-acetaminophen group than those in the fentanyl group.
  
  
  CONCLUSIONS
  Acetaminophen has significant fentanyl-sparing effects and reduces side effects when combined with fentanyl in intravenous parent-/nurse-controlled analgesia for postoperative pediatric pain management.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jeong-Yeon
authors.initials: JY
authors.lastname: Hong
authors.forename: Won Oak
authors.initials: WO
authors.lastname: Kim
authors.forename: Bon Nyeo
authors.initials: BN
authors.lastname: Koo
authors.forename: Jin Sun
authors.initials: JS
authors.lastname: Cho
authors.forename: Eun H
authors.initials: EH
authors.lastname: Suk
authors.forename: Hae Keum
authors.initials: HK
authors.lastname: Kil
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D002675:Child, Preschool; D003559:Cystostomy / Q000009:adverse effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D024802:Nurse's Role; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010290:Parents; D011446:Prospective Studies; D014519:Ureterostomy / Q000009:adverse effects*
chemical_list: D000082:Acetaminophen; D005283:Fentanyl