Clinicians are seeking ways to reduce opioid exposure in a variety of settings. Could the use of acetaminophen before opioid use reduce opioid treatment duration in the inpatient setting?
Opioids can be a highly effective way to manage pain, but with increasing scrutiny on opioid use and duration, it’s become imperative to find ways to reduce the duration of treatment. An investigation examines whether providing intravenous acetaminophen before introducing opioids could reduce the duration of opioid therapy during inpatient care.1
Investigators ran a comparative effectiveness research study that looked at data for pediatric inpatients from 274 hospitals across the United States between January 2011 and June 2016. They compared outcomes using propensity score-matched analysis. Patients who only received intravenous opioids were the control cohort and those who received intravenous acetaminophen were the intervention group.
A pool of 893,293 pediatric patients were included in the evaluation with 287,504 given intravenous opioids and 18,197 given intravenous acetaminophen. Investigators removed patients who did not receive intravenous opioids, those without diagnostic information, and those without hospital information, leaving 118,908 receiving intravenous opioids and 16,068 received intravenous acetaminophen Additionally, patients who were given acetaminophen after receiving opioids were also excluded. In comparison to patients who only received opioids, those who had acetaminophen and then opioids were older (eg, ages 13 to 22 years: 59.1% [1027 patients] vs 56.4% [58 021 patients]; P < .001) and not mechanically ventilated (97.4% [1693 patients] vs 95.2% [97 858 patients]; P < .001); and were more likely to have a body temperature above 38° C (3.1% [54 patients] vs 1.7% [1706 patients]; P < .001). Following propensity match scoring, the median duration of intravenous opioid use was 33.5 hours (5.4-74.0 hours) for the control group and for the intervention group was 27.7 hours (4.0-76.1 hours) (P = .41).
The investigators concluded that the use of intravenous acetaminophen before the administration of intravenous opioids was linked to a 15.5% reduction in the duration of opioid treatment. They believe that creating a pain management regimen that uses acetaminophen first could be a key way to reduce opioid exposure.
1. Patel A, Gai J, Trujillo-Rivera E, et al. Association of intravenous acetaminophen administration with the duration of intravenous opioid use among hospitalized pediatric patients. JAMA Netw Open. 2021;4(12):e2138420. doi:10.1001/jamanetworkopen.2021.38420