Multimodal Analgesic use of Intravenous Acetaminophen/Paracetamol in the Pediatric Surgical Patient: A Systematic Review and Synthesis (2016)

Undergraduates: John Escano, Cecelia Roscigno, RN, PhD, CNRN

Faculty Advisor: Cecelia Roscigno
Department: Nursing

---

Intravenous acetaminophen, or paracetamol, was examined as a multimodal analgesic approach to managing pain in adult surgical populations, but there is a paucity of data on its use in a multimodal approach in pediatric surgical patients. The purpose of this systematic review and synthesis is to examine and explain what is known about intravenous acetaminophen/paracetamol for effecting multimodal analgesia in the pediatric surgical population. We conducted a literature search across three major search engines (PubMed, Embase, and Cochrane Central Register of Controlled Trials) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We consulted a health sciences research librarian to develop appropriate search strategies for each search engine. Each abstract or article was first evaluated for inclusion criteria: (1) focus on intravenous acetaminophen; (2) pediatric population (<18); (3) multimodal approach to pain management; (4) full-text article; (5) English language; and (6) peer-reviewed. Publications were independently analyzed by two reviewers to discern the quality, approach, findings, effects, and limitations to be considered. A total of N = 3781 articles were first identified. After excluding for: a) duplicates (n = 689); and b) not meeting inclusion criteria (n = 3087), we had a total of n = 5 articles. From this small number of studies, the findings suggest that intravenous acetaminophen can be used within a multimodal approach, has the potential to produce opioid-sparring effects, decrease pain scores over time, and improve patient outcomes. More research is needed in this population.