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January 9, 2013

Pain Panacea for Opiophobia in Infants?

Author Affiliations

Author Affiliations: Department of Pediatrics, University of Tennessee Health Science Center; and Children's Foundation Research Center, Le Bonheur Children's Hospital, Memphis.

JAMA. 2013;309(2):183-184. doi:10.1001/jama.2012.208359

Intravenous acetaminophen (paracetamol) is suggested for use as an opioid-sparing analgesic for children requiring surgery1 or emergency care,2 despite limited data on its efficacy and toxicity in infants and children. In this issue of JAMA, the randomized trial by Ceelie and colleagues3 addresses this evidence gap by showing clinically significant reductions in morphine use among neonates or infants receiving postoperative analgesia. Among patients randomized to receive acetaminophen (n = 33) or morphine (n = 38) postoperatively, the cumulative morphine dose during the first 48 hours following surgery was 121 μg/kg (interquartile range, 99-264) vs 357 μg/kg (interquartile range, 220-605), respectively—a 66% relative reduction between groups (P < .001). There were no differences in the number of patients requiring morphine rescue doses or in pain scores.