Intravenous Acetaminophen For the Management of Pain During Vaso-occlusive Crises in Pediatric Patients

Abstract

Background: Children with sickle cell disease experience vaso-occlusive crises (VOC) that requires opioid pharmacotherapy. Multimodal analgesic therapy may reduce pain and opioid-induced adverse effects.

Objective: The primary objective was to examine the effectiveness of intravenous (IV) acetaminophen in children presenting with pain from VOC. Secondary objectives were to document the safety and opioid-sparing effects of IV acetaminophen during VOC in pediatric patients.

Setting: Children's Medical Center, NYU-Winthrop Hospital.

Method: This retrospective study had two groups of patients, those who received opioids alone (group O) and those who received acetaminophen with opioids (group OA). Children two to 19 years of age who were admitted to the children's medical center for VOC were eligible for inclusion.

Main outcome measure: A reduction in pain by at least 1 out of 10. With every analgesic dose, we documented pain scales and pain scores before and after each dose, the number of doses administered per day, and mg/kg/day. Data were analyzed using the mixed effect model. All opioids administered to patients were converted to morphine equivalents. We documented length of stay and adverse events.

Results: We had a total of 46 children: 28 in group O and 18 in group OA. Acetaminophen reduced the pain from VOC by 2.3/10. There were trends in different assessments of opioid-sparing effects, in reducing opioid dosage (-0.5 mg/kg morphine equivalent; P = 0.45), reducing overall morphine equivalent doses (-18.5 mg; P = 0.066), and opioid-related adverse effects.

Conclusion: This is the first study to demonstrate the effectiveness of IV acetaminophen in treating VOC pain in children, supporting multimodal analgesic therapy in this setting. Opioid-sparing effects were also encouraging.

Keywords: acetaminophen IV; children; opioid; pain; sickle cell disease.

Figure 1

Opioid Dosing Requirements in Morphine Equivalents, Mg/Kg/Day (Acetaminophen ± Opioid Group and Opioid-Only Group) Trend in Dosing Requirements of Opioids

Figure 2

Number of Opioid Doses on Admission Days 1 Through 5 (Acetaminophen ± Opioid Group and Opioid-Only Group) Count of Opioids Administered Over First Five Days