Surgery Pain Relief Option for Babies

Morphine for babies undergoing surgery can be supplemented effectively with acetaminophen

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Babies undergoing surgery require pain relief like anyone else. But morphine can have risky side effects for little bodies. Now a more common pain reliever might help out.

A recent study found that giving babies acetaminophen (Tylenol) through an IV after surgery lets doctors reduce the amount of morphine the babies received.

The amount of pain and side effects in this study were not different between a group of babies receiving only morphine and a group receiving morphine and acetaminophen.

That means that receiving a smaller amount of morphine, plus acetaminophen, appears to be a valid option for babies' pain relief after surgery.

"Attend all well child visits."

The study, led by Ilse Ceelie, MD, PhD, from the Intensive Care and Department of Pediatric Surgery at Erasmus MC-Sophia Children's Hospital in the Netherlands, focused on the effects of adding intravenous acetaminophen, also called paracetamol, to a baby's pain management after surgery.

At three pediatric intensive care units in Rotterdam, 71 babies under age 1 were included in the study if they were receiving major thoracic or abdominal surgery (not including heart surgery).

All the babies received a standard dose of morphine for their age and size 30 minutes before their surgery ended.

Then, half received continuous morphine through an IV for the next two days while the other half received intermittent acetaminophen through IV for two days. Babies in both groups immediately received additional morphine as necessary when they showed pain using a standard pain assessment.

The researchers found that the 33 babies receiving acetaminophen ended up getting 66 percent less morphine during the 48 hours after surgery than the 38 babies who only received morphine.

While the median dose among those receiving acetaminophen was 121 μg/kg, the median dose in the morphine-only group was 357 μg/kg. The range of doses across all the babies in the acetaminophen group was 99 to 264 μg/kg, compared to 220 to 605 μg/kg in the morphine-only group.

When the researchers divided the children by age, they found the newborns (0 to 10 days old) who got acetaminophen received 49 percent less morphine than the newborns who did not. The older children (11 days to 1 year old) got 73 percent less morphine if they also got acetaminophen, compared to the morphine-only group.

Meanwhile, the pain scores did not differ between the two groups. Neither did the adverse events (side effects or negative effects from treatment).

The study was limited by its small size overall, which made it statistically not possible to measure adverse effects in both groups.

Yet the study did show that using acetaminophen along with morphine was apparently an effective alternative to using only morphine.

"These results suggest that intravenous paracetamol may be an interesting alternative as primary analgesic in neonates and infants," the authors wrote.

The study was published January 8 in JAMA. The research was funded by a grant from ZonMw Priority Medicine for Children. The researchers reported no conflicts of interest.

Reviewed by: 
Review Date: 
January 8, 2013
Last Updated:
January 8, 2013