Effect of Intraoperative Intravenous Acetaminophen Administration on Opioid Requirements in Children Undergoing Complex Cranial Vault Reconstruction for Craniosynostosis
Lohit Velagapudi, Christy J. Crockett, Amy X. Zhang, Kyle M. Hocking, Christopher M. Bonfield, Srijaya K. ReddyBackground:
Pediatric complex cranial vault reconstruction (CCVR) for repair of craniosynostosis is associated with significant analgesic requirements. Intravenous acetaminophen (IVAPAP) has been shown to be effective in reducing opioid requirements for other types of pediatric surgery. However, the efficacy of IVAPAP in CCVR has not been established. The aim of this study was to determine the impact of IVAPAP on perioperative opioid requirements for CCVR.
Methods:
Children 12 years of age or younger who underwent CCVR between June 2017 and August 2020 were retrospectively evaluated. The cohorts were patients who received intraoperative IVAPAP and those who did not. Patients who received other nonopioid intravenous (IV) analgesics intraoperatively were excluded. The primary outcome measure was intraoperative opioid requirements. Secondary outcome measures were postoperative opioid requirements, time to first opioid and total opioid requirement in the first 24 hours postoperatively. Opioid requirements were calculated using conversion to weight-based (mg/kg) IV morphine equivalents.
Results:
One hundred two patients met the inclusion criteria with 52 patients in the IVAPAP cohort and 50 in the non-IVAPAP cohort. Patients who received IVAPAP required significantly less postoperative oxycodone than those who did not receive IVAPAP. There were no differences in demographics, intraoperative opioid requirements, or total opioid requirement in the first 24 hours postoperatively between the 2 groups.
Conclusions:
Intraoperative IVAPAP is associated with reduced postoperative oxycodone administration. A prospective randomized controlled trial is needed to further investigate these findings.