Document Detail


Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial.
MedLine Citation:
PMID:  23299606     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: Continuous morphine infusion as standard postoperative analgesic therapy in young infants is associated with unwanted adverse effects such as respiratory depression.
OBJECTIVE: To determine whether intravenous paracetamol (acetaminophen) would significantly (>30%) reduce morphine requirements in neonates and infants after major surgery.
DESIGN, SETTING, AND PATIENTS: Single-center, randomized, double-blind study conducted in a level 3 pediatric intensive care unit in Rotterdam, The Netherlands. Patients were 71 neonates or infants younger than 1 year undergoing major thoracic (noncardiac) or abdominal surgery between March 2008 and July 2010, with follow-up of 48 hours.
INTERVENTIONS: All patients received a loading dose of morphine 30 minutes before the end of surgery, followed by continuous morphine or intermittent intravenous paracetamol up to 48 hours postsurgery. Infants in both study groups received morphine (boluses and/or continuous infusion) as rescue medication on the guidance of the validated pain assessment instruments.
MAIN OUTCOME MEASURES: Primary outcome was cumulative morphine dose (study and rescue dose). Secondary outcomes were pain scores and morphine-related adverse effects.
RESULTS: The cumulative median morphine dose in the first 48 hours postoperatively was 121 (interquartile range, 99-264) μg/kg in the paracetamol group (n = 33) and 357 (interquartile range, 220-605) μg/kg in the morphine group (n = 38), P < .001, with a between-group difference that was 66% (95% CI, 34%-109%) lower in the paracetamol group. Pain scores and adverse effects were not significantly different between groups.
CONCLUSION AND RELEVANCE: Among infants undergoing major surgery, postoperative use of intermittent intravenous paracetamol compared with continuous morphine resulted in a lower cumulative morphine dose over 48 hours.
TRIAL REGISTRATION: trialregister.nl Identifier: NTR1438.
Authors:
Ilse Ceelie; Saskia N de Wildt; Monique van Dijk; Margreeth M J van den Berg; Gerbrich E van den Bosch; Hugo J Duivenvoorden; Tom G de Leeuw; Ron Mathôt; Catherijne A J Knibbe; Dick Tibboel
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-01-10     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  149-54     Citation Subset:  AIM; IM    
Affiliation:
Intensive Care and Department of Pediatric Surgery, Erasmus MC–Sophia Children's Hospital, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / administration & dosage*
Analgesia / methods
Analgesics, Non-Narcotic / administration & dosage*
Analgesics, Opioid / administration & dosage*,  adverse effects
Double-Blind Method
Female
Humans
Infant
Infant, Newborn
Infusions, Intravenous
Male
Morphine / administration & dosage*,  adverse effects
Pain Measurement
Pain, Postoperative / prevention & control*
Postoperative Care
Surgical Procedures, Operative*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid; 103-90-2/Acetaminophen; 57-27-2/Morphine
Comments/Corrections
Comment In:
JAMA. 2013 Jan 9;309(2):183-4   [PMID:  23299611 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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