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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23747    [Epub ahead of print]
Published online February 20, 2024.
Comparison of preemptive and preventive intravenous acetaminophen on opioid consumption in pediatrics undergoing posterior spinal fusion surgery: a randomized controlled trial
Yeon Ju Kim1  , Ha-Jung Kim1  , Sehee Kim2  , Hyungtae Kim1  , Choon Sung Lee3  , Chang Ju Hwang3  , Jae Hwan Cho3  , Young-Jin Ro1  , Won Uk Koh1 
1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author:  Won Uk Koh, Tel: +82-2-3010-5606, Fax: +82-2-3010-6790, 
Email: wu.koh@amc.seoul.kr
Received: 10 October 2023   • Revised: 25 January 2024   • Accepted: 13 February 2024
Abstract
Background
Posterior spinal fusion (PSF), commonly used for adolescent idiopathic scoliosis (AIS), causes severe postoperative pain. Intravenous (IV) administration of acetaminophen has shown promise for opioid-sparing analgesia; however, its analgesic effect and optimal timing for its standard use remain unclear. Our study aimed to evaluate the analgesic effect and optimal timing of IV acetaminophen administration in pediatric and adolescent patients undergoing PSF and requiring adequate pain control.
Methods
This prospective, randomized, triple-blind trial was conducted in patients aged 11–20 undergoing PSF. Participants were randomized into three groups: the preemptive group (received IV acetaminophen 15 mg/kg after anesthetic induction/before surgical incision), the preventive group (received IV acetaminophen 15 mg/kg at the end of surgery/before skin closure), and the placebo group. The primary outcome was cumulative opioid consumption during the first 24 h postoperatively.
Results
Among the 99 enrolled patients, the mean ± standard deviation (SD) amount of opioid consumption during the postoperative 24 h was 60.66 ± 23.84, 52.23 ± 22.43, and 66.70 ± 23.01 mg in the preemptive, preventive, and placebo groups, respectively (overall P = 0.043). A post hoc analysis revealed that the preventive group had significantly lower opioid consumption than the placebo group (P = 0.013). However, no significant differences between the groups were observed for the secondary outcomes.
Conclusions
The preventive administration of scheduled IV acetaminophen reduces cumulative opioid consumption without increasing the incidence of drug-induced adverse events in pediatric and adolescent patients undergoing PSF.
Key Words: Acetaminophen; Analgesics, opioid; Pain; Pediatrics; Prospective studies; Spinal fusion.
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