Category: Professional Posters
Purpose: Intravenous acetaminophen is significantly more expensive than oral or rectal formulations. Numerous studies to date have shown that oral or rectal formulations of acetaminophen are as equally efficacious as the intravenous formulation in reducing opioid requirements in the post-operative period. At our institution, costs associated with the use of intravenous acetaminophen have increased exponentially, yet 76% of doses are being given within 4 hours of another oral medication. In light of this, it was important to quantify the clinical benefit of a more costly alternative by analyzing post-operative opioid requirements in patients who received concomitant intravenous or oral acetaminophen.
Methods: This study is a pilot analysis of post-operative opioid requirements in pediatric patients who received concomitant intravenous or oral acetaminophen as part of a multimodal approach to the treatment of pain after a procedure. The analysis included all patients who underwent an appendectomy, external ventricular drain placement, or spinal fusion repair in 2017, and also received at least four (4) doses of intravenous or oral acetaminophen in the first 36 hour post-operative period. Patients who received a combination of both formulations were excluded. The mean intravenous morphine milligram equivalents (MME) of the total opioid requirement per patient was compared between those patients who received intravenous versus oral acetaminophen.
Results: Of 103 total patients, 53 patients were included in the analysis, of which 71.6% received intravenous acetaminophen post-operatively. The majority of the patients were admitted for an appendectomy (67.9%). Patients who received the intravenous formulation had a higher number of acetaminophen doses (5.03 versus 4.13 doses, p=0.001) and were not significantly different in age (9.24 years vs. 8.07 years, p=0.43). The mean total MME per patient in the first 36 hour post-operative period was higher in patients who received intravenous acetaminophen versus oral acetaminophen (6.16 mg vs. 5.23 mg, p=0.65), though this did not reach statistical significance. The majority of the patients received intravenous morphine (90.5%). In a subgroup analysis of appendectomy patients, the mean MME required per patient in the first 36 hour post-operative period was higher in the intravenous group compared to the oral group (8.3 mg vs. 3.60 mg, p=0.024).
Conclusion: In this pilot analysis of multiple procedures, the data suggests that there are no significant differences in opioid requirements in patients who received intravenous versus oral acetaminophen in the first 36 hour post-operative period. Total mean MME was higher for appendectomy patients who received intravenous acetaminophen. Due to the high cost of intravenous acetaminophen, careful considerations should be made at a formulary level regarding appropriate restriction criteria, and utilization should be analyzed on an on-going basis. This data supports the need for a more robust review in pediatric patients across a larger cross-section of patients and procedures.