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Acetaminophen Improves Analgesia but Does Not Reduce Opioid Requirement After Major Spine Surgery in Children and Adolescents

Hiller, Arja PhD, MD*; Helenius, Ilkka PhD, MD; Nurmi, Elisa MD*; Neuvonen, Pertti J. PhD, MD; Kaukonen, Maija PhD, MD§; Hartikainen, Tuula RN*; Korpela, Reijo MD*; Taivainen, Tomi PhD, MD*; Meretoja, Olli A. MD*

doi: 10.1097/BRS.0b013e318263165c
Randomized Trial

Study Design. A randomized, placebo-controlled, double-blind study to evaluate the effect of intravenously (IV) administered acetaminophen on postoperative pain in children and adolescents undergoing surgery for idiopathic scoliosis or spondylolisthesis.

Objective. To evaluate effectiveness of IV-administered acetaminophen on postoperative analgesia, opioid consumption, and acetaminophen concentrations after major spine surgery in adolescents.

Summary of Background Data. Scoliosis surgery is associated with severe postoperative pain, most commonly treated with IV-administered opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs), as adjuvant to opioids, improve analgesia and reduce the need for opioids. However, by inhibiting cyclo-oxygenase enzymes peripherally, NSAIDs may inhibit bone healing. Acetaminophen, a centrally acting analgesic, does not have the adverse effects of NSAIDs and has improved analgesia in children after another orthopedic surgery.

Methods. In an institutional review board approved study, 36 American Society of Anesthesiology patient classification I to III patients of 10 to 18 years of age were analyzed. Acetaminophen 30 mg/kg, administered IV or 0.9% NaCl was administered at the end of scoliosis or spondylolisthesis surgery, and thereafter twice at 8-hour intervals. Timed blood samples for acetaminophen determination were taken between 0.25 and 20 hours after the first dose. All patients received standard propofol-remifentanil anesthesia. Pain scores (visual analogue scale [VAS], 0–10), opioid consumption, and adverse effects were recorded.

Results. In the surgical ward, 7 (39%) patients in the acetaminophen and 13 (72%) in the placebo group had a VAS pain score 6 or more (P < 0.05). There were fewer hours with VAS score 6 or more in the acetaminophen group compared with the placebo group (8.7% vs. 17.8% of the hours, P < 0.05). There was no difference in oxycodone consumption during the 24-hour follow-up between the 2 groups.

Conclusion. IV-administered acetaminophen 90 mg/kg/day, adjuvant to oxycodone, did improve analgesia, but did not diminish oxycodone consumption during 24 hours after major spine surgery in children and adolescents. All acetaminophen concentrations were in nontoxic levels.

The analgesic and opioid-sparing effect of acetaminophen was evaluated in 36 children and adolescents undergoing major spine surgery in a randomized, double-blind, clinical trial. The results showed that analgesia was improved, but acetaminophen did not diminish oxycodone consumption during the first 24 hours after spine surgery. All patients have undergone spinal fusion during the 2-year follow-up.

*Department of Anesthesia, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

Department of Pediatric Orthopedics and Traumatology, Turku University Central Hospital, Turku, Finland

Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland

§Department of Intensive Care, University of Helsinki, Helsinki, Finland.

Address correspondence and reprint requests to Arja Hiller, PhD, MD, Department of Anesthesia, Hospital for Children and Adolescents, University of Helsinki, PL 281 HUS00029 Helsinki, Finland; E-mail:

Acknowledgment date: January 13, 2012. First revision date: March 22, 2012. Second revision date: May 28, 2012. Acceptance date: June 5, 2012.

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in authors' country.

Finnish Pediatric Research Foundation and Medtronic International Baxter International grant funds were received to support this work. Also supported, in part, by the Institute of Helsinki University Central Hospital.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: for example, honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.