Featured Research

from universities, journals, and other organizations

Post-operative intravenous acetaminophen may help reduce use of morphine in infants

Date:
January 8, 2013
Source:
JAMA and Archives Journals
Summary:
Among infants undergoing major surgery, postoperative use of intermittent intravenous paracetamol (acetaminophen) for the management of pain resulted in a lower cumulative morphine dose over 48 hours.

Among infants undergoing major surgery, postoperative use of intermittent intravenous paracetamol (acetaminophen) for the management of pain resulted in a lower cumulative morphine dose over 48 hours, according to a study appearing in the January 9 issue of JAMA.

Opioid therapy for the treatment of pain is associated with adverse effects. Researchers are seeking alternative analgesic regimens in neonates and infants, according to background information in the article. Paracetamol has been proposed as an alternative, with one study showing promise.

Ilse Ceelie, M.D., Ph.D., of Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands, and colleagues performed a trial with infants who had undergone major abdominal and thoracic (noncardiac) surgery to determine if intravenous paracetamol would reduce the cumulative morphine dose needed to provide adequate analgesia by at least 30 percent. The randomized study was conducted in a pediatric intensive care unit and included 71 patients (neonates or infants younger than 1 year) undergoing surgery between March 2008 and July 2010, with follow-up of 48 hours. All patients received a 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 as rescue medication based on the guidance of the validated pain assessment instruments.

The researchers found that the cumulative morphine dose in the paracetamol group was 66 percent lower than that in the morphine group (median [midpoint], 121 μg/kg per 48 hours vs. 357 μg/kg per 48 hours). "Considering the 2 stratified age groups separately, the cumulative morphine dose in the paracetamol group was 49 percent lower than that in the morphine group for the neonates (age 0 through 10 days) (median, 111 μg/kg per 48 hours vs. 218 μg/kg per 48 hours) and 73 percent lower for the older infants (aged 11 days to 1 year) (median, 152 μg/kg per 48 hours vs. 553 μg/kg per 48 hours)."

The authors also found that neither the total morphine rescue dose, the amount or number of morphine rescue doses or the number of patients requiring rescue doses differed significantly between the paracetamol and morphine groups. Also, there were no significant differences for percentage of adverse effects or pain scores between treatment groups.

"This randomized controlled trial shows that infants who receive intravenous paracetamol as primary analgesic after major surgery require significantly less morphine than those who receive a continuous morphine infusion. Judging from the rescue morphine doses, a similar level of analgesia was obtained in either group. These results suggest that intravenous paracetamol may be an interesting alternative as primary analgesic in neonates and infants," the authors conclude.

Editorial: Pain Panacea for Opiophobia In Infants?

Kanwaljeet J. S. Anand, M.B.B.S., D.Phil., F.R.C.P.C.H., of the University of Tennessee Health Science Center and Children's Foundation Research Center, Le Bonheur Children's Hospital, Memphis, comments on the findings of this study in an accompanying editorial.

"Titrating morphine analgesia carefully (based on pain scores) is more labor intensive than the common practice of slightly oversedating infants who require opioid analgesia for painful conditions, such as following operations. However, this approach may avoid the respiratory depression, hypotension, and opioid tolerance observed in many centers. Busy clinical units will have to choose between the nursing resources required to follow such a labor-intensive protocol or to tolerate a relatively low incidence of oversedation and opioid-related adverse effects. Theoretically elegant approaches have little value in clinical practice if they are not practically feasible in the clinical settings for which they were designed. However, research studies such as the report by Ceelie et al are invaluable because they bring methodological rigor and continue to set new standards for future clinical practice."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Ilse Ceelie et al. Effect of Intravenous Paracetamol on Postoperative Morphine Requirements in Neonates and Infants Undergoing Major Noncardiac Surgery: A Randomized Controlled Trial. JAMA, January 8, 2013 DOI: 10.1001/jama.2012.148050

Cite This Page:

JAMA and Archives Journals. "Post-operative intravenous acetaminophen may help reduce use of morphine in infants." ScienceDaily. ScienceDaily, 8 January 2013. <www.sciencedaily.com/releases/2013/01/130108162225.htm>.
JAMA and Archives Journals. (2013, January 8). Post-operative intravenous acetaminophen may help reduce use of morphine in infants. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2013/01/130108162225.htm
JAMA and Archives Journals. "Post-operative intravenous acetaminophen may help reduce use of morphine in infants." ScienceDaily. www.sciencedaily.com/releases/2013/01/130108162225.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins