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IV acetaminophen lowered postop morphine need in neonates, infants

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Is IV acetaminophen practical

Carefully titrating morphine based on frequent assessments of infants’ pain "is more labor-intensive than the common practice of slightly oversedating infants who require opioid analgesia for painful conditions, such as following operations," said Dr. Kanwaljeet J.S. Anand.

"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 setting for which they were designed," he noted.

Kanwaljeet J.S. Anand, MBBS, D.Phil., is in the department of pediatrics at the University of Tennessee Health Science Center and at Children’s Foundation Research Center, Le Bonheur Children’s Hospital, both in Memphis. He reported no financial conflicts of interest. These remarks were taken from his editorial accompanying Dr. Ceelie’s report (JAMA 2013;309:183-4).


 

FROM JAMA

Neonates have a lower risk of acetaminophen-induced hepatotoxicity than do older children and adults because the enzymes, such as CYP2E1, necessary for the hepatotoxic metabolite to develop are still immature, the researchers noted.

This study was limited in that it involved a strictly defined patient population at a single medical center, so the findings may not be widely generalizable. Moreover, liver function was not monitored in the acetaminophen group, and the study was underpowered to detect a difference in adverse effects, which "limits our ability to determine which treatment was safest," Dr. Ceelie and her colleagues said.

The study was supported by a grant from ZonMw Priority Medicines for Children. The authors reported no potential conflicts of interest.

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