Choosing Wisely:

Reduce postoperative opioid requirements in pediatric patients by administering acetaminophen and/or NSAID medications in the perioperative period.

Rationale and Comments: Multimodal analgesia is recommended in the management of children for their perioperative pain. Significant decreases in opioid consumption can be achieved with the concurrent use of NSAIDs and/or acetaminophen in infants and children undergoing surgery of moderate or major severity, especially within the first 24 hours following surgery. The use of NSAIDs during the first 24 hours of postoperative care also reduced the incidence of nausea and vomiting. In addition to decreasing the possibility of narcotic dependence, avoidance of opioids confers added benefits of reducing the incidence of postoperative nausea and constipation and aiding in early ambulation.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Surgery
  • Sources:
  • Meta-analysis
  • Disciplines:
  • Surgical
  • Pediatric
  • References: • Wong I, St John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs in children. Paediatric Anaesthesia. 2013 Jun;23(6):475-495.
    • Michelet D, Andreu-Gallien J, et al. A meta-analysis of use of nonsteroidal anti-inflammatory drugs for pediatric postoperative pain. Anesthesia Analgesia. 2012 Feb;114(2):393-406.
    • Brasher C, Gafsous B, et al. Postoperative pain management in children and infants: an update. Pediatric Drugs. 2014 April;16(2):129-140.
    • Ceelie I, de Wildt SN, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery. JAMA. 2013 Jan 9;309(2):149-154.

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