(26 - Friday) Evaluation of acetaminophen as adjunct analgesia to reduce opioid use in pediatric patients undergoing cardiac surgery; A retrospective analysis.

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Abstract: Postoperative acetaminophen use has been shown to reduce opioid consumption in adult cardiac patients, however data is limited in pediatric cardiac surgery patients.  Opioids are commonly utilized for post op analgesia in pediatric patients following cardiac surgery, however opioid use is associated with known negative side effects, including diminished neurodevelopmental outcomes, dependence, respiratory depression, increased duration of mechanical ventilation, and increased intensive care days and hospital length of stay. To evaluate if acetaminophen use could reduce postoperative opioid consumption in pediatric cardiac surgery patients, we conducted a retrospective review of pediatric patients receiving acetaminophen after cardiac surgery in the PCICU.

This was a single-center, retrospective review of pediatric cardiac surgery patients who received at least 48 hours IV or PO acetaminophen compared to patients who received less than 48 hours of postoperative acetaminophen between January 2018 and October 2021. Pain management practices in the PCICU evolved throughout this three-year span. Prior to 2019, patients were treated before implementation of protocols. In 2019 pain medications were prescribed after increased education regarding opioid use in the PCICU occurred. Implementation of a multimodal pain management algorithm, which included 48 hours of post op acetaminophen and Ketorolac, occurred in October 2020. Patients treated after the implementation of this algorithm were included in 2021 data. A total of 273 patients undergoing cardiac surgery limited to on pump cardiopulmonary bypass were included. Patients were excluded if they received a PCA postoperatively or if death occurred during admission. The primary outcome was 48-hour postoperative opioid consumption expressed as median morphine equivalents per weight (MME/kg). Secondary outcomes included postoperative opioid consumption for the entire hospital admission, and both 48 hour and entire admission postoperative opioid consumption for STAT categories 1-3 and 4-5.  

A total of 273 patients were included in the review, with the STAT category distribution for each year shown in Figure 1. Forty-eight hours after surgery and entire admission opioid consumption and was significantly lower for all patients who received 48 hours of acetaminophen compared to those who did not (1.5 vs 1.08 mg MME/kg, p=0.037; and 2.2 vs 1.2 mg MME/kg, p=0.012). These same results were also significantly lower for patients in 2018 (2.2 vs 1.07 mg MME/kg, p=0.027; and 4.8 vs 1.2 mg MME/kg, p=0.013). Although not statistically significantly, both 48 hour postoperative and entire admission opioid consumption for patients in 2019 decreased in those patients who received 48 hours of acetaminophen. For patients in 2021, there was no difference in 48 hours postoperative or entire admission opioid consumption.    

The use of 48 hours of postoperative acetaminophen resulted in decreased opioid usage in both the first 48 hours postoperatively and the entire admission. This decrease in opioid usage was sustained throughout two additional years, further confirming the use of acetaminophen as adjunct analgesia can reduce opioid consumption in pediatric cardiac surgery patients.