Acetaminophen & NICU
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Acetaminophen is remarkable.
We started using it intravenously before I retired - my patients needed less opioids during surgery, and afterward, patients did much better.
But...
Then, the bean counters got involved, and told us that its use should be restricted because it was so expensive as an intravenous formulation (Ofirmev
). The fact that patients went home sooner, had fewer complications, etc was irrelevant. Paying $16-$20 a bottle four times a day was way too much to spend.However, recent studies seem to indicate that oral administration (which you can't do in the NICU, obviously) is just as effective IF you give enough. I've been singing the praises of a gram every six hours for a long time. Don't exceed, because your liver can fall out, but it's a great analgesic.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485512/
For patients who can take an oral dosage form, no clear indication exists for preferential prescribing of IV acetaminophen. Decision-making must take into account the known adverse effects of each dosage form and other considerations such as convenience and cost. Future studies should assess multiple-dose regimens over longer periods for patients with common pain indications such as cancer, trauma, and surgery.
https://emj.bmj.com/content/35/3/179
Overall, there was a small but clinically significant decrease in pain in each group. No superiority was demonstrated in this trial with intravenous paracetamol compared with oral paracetamol in terms of efficacy of analgesia and no difference in length of stay, patient satisfaction, need for rescue analgesia or side effects.
I wonder what @bachophile's experience with post-op analgesia is these days.
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There wasn’t IV Tylenol when I practiced. But respiratory depression remains real, as does the effect on MAP with morphine, ..mif they still give morphine now. Many more prems undergo surgery now .. they are lighter and younger too. The procedures are more complex and invasive. The IV route, esp. central, is preferable for all meds because tiny stomachs don’t absorb drugs predictably. As to what you, Ax, questioned, NICU & PICU nurses (those with experience, that is) are pretty astute picking up pain signals with neonates. Sometimes it’s vital signs, sometimes it’s posturing, cries or lack thereof, sweating, grimacing, facials, lots of stuff. Knowing the babe shift to shift, their changes in behaviour, knowing the parents too and how they see their babe hour to hour, lots of stuff.
