Acetaminophen improves analgesia but does not reduce opioid requirement after major spine surgery in children and adolescents.
METHODS
A randomized, placebo-controlled, double-blind study to evaluate the effect of intravenously (IV) administered acetaminophen on postoperative pain in children and adolescents undergoing surgery for idiopathic scoliosis or spondylolisthesis.


OBJECTIVE
To evaluate effectiveness of IV-administered acetaminophen on postoperative analgesia, opioid consumption, and acetaminophen concentrations after major spine surgery in adolescents.


BACKGROUND
Scoliosis surgery is associated with severe postoperative pain, most commonly treated with IV-administered opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs), as adjuvant to opioids, improve analgesia and reduce the need for opioids. However, by inhibiting cyclo-oxygenase enzymes peripherally, NSAIDs may inhibit bone healing. Acetaminophen, a centrally acting analgesic, does not have the adverse effects of NSAIDs and has improved analgesia in children after another orthopedic surgery.


METHODS
In an institutional review board approved study, 36 American Society of Anesthesiology patient classification I to III patients of 10 to 18 years of age were analyzed. Acetaminophen 30 mg/kg, administered IV or 0.9% NaCl was administered at the end of scoliosis or spondylolisthesis surgery, and thereafter twice at 8-hour intervals. Timed blood samples for acetaminophen determination were taken between 0.25 and 20 hours after the first dose. All patients received standard propofol-remifentanil anesthesia. Pain scores (visual analogue scale [VAS], 0-10), opioid consumption, and adverse effects were recorded.


RESULTS
In the surgical ward, 7 (39%) patients in the acetaminophen and 13 (72%) in the placebo group had a VAS pain score 6 or more (P < 0.05). There were fewer hours with VAS score 6 or more in the acetaminophen group compared with the placebo group (8.7% vs. 17.8% of the hours, P < 0.05). There was no difference in oxycodone consumption during the 24-hour follow-up between the 2 groups.


CONCLUSIONS
IV-administered acetaminophen 90 mg/kg/day, adjuvant to oxycodone, did improve analgesia, but did not diminish oxycodone consumption during 24 hours after major spine surgery in children and adolescents. All acetaminophen concentrations were in nontoxic levels.
Department of Anesthesia, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. arja.hiller@hus.fi
Arja
A
Hiller
Ilkka
I
Helenius
Elisa
E
Nurmi
Pertti J
PJ
Neuvonen
Maija
M
Kaukonen
Tuula
T
Hartikainen
Reijo
R
Korpela
Tomi
T
Taivainen
Olli A
OA
Meretoja
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D061605:Administration, Intravenous; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000139:chemically induced; D010098:Oxycodone / Q000009:adverse effects / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use; D000077208:Remifentanil; D012600:Scoliosis / Q000601:surgery; D013122:Spinal Diseases / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D010880:Piperidines; D000082:Acetaminophen; D010098:Oxycodone; D000077208:Remifentanil; D015742:Propofol