October 23, 2013
Adding IV Acetaminophen Reduces Costs in
Pediatric Tonsillectomy

San Francisco—Combining IV acetaminophen with narcotics provides better pain relief for children undergoing tonsillectomies, according to a new study that suggests the benefits go far beyond just that.

Researchers from the Cincinnati Children’s Hospital Medical Center said the practice also reduces the need for more powerful painkillers after surgery—and the associated costs—while reducing side effects and allowing slightly quicker hospital discharge than when pediatric patients receive narcotics alone. The data was presented at the recent Anesthesiology 2013 meeting held by the American Society of Anesthesiologists in San Francisco.

The need for better pain control is driven by changes in why tonsillectomy is performed, according to background in the report. While the surgery on more than 500,000 patients a year usually was done in the past as a remedy for multiple tonsil infections, more than 80% of tonsillectomies now are performed to correct breathing disorders that affect sleep, such as sleep apnea.

Earlier this year, the FDA issued a black box warning against the use of codeine in children undergoing tonsillectomies or adenoidectomies because certain children are “ultra-rapid metabolizers” who have an inherited ability that causes their liver to convert codeine into life-threatening or fatal amounts of morphine. Furthermore, research has suggested that children with sleep apnea are highly sensitive to narcotic medications because there is a direct correlation between hypoxemia and increased morphine sensitivity for these children.

“Since the majority of tonsillectomies are done for sleep apnea, physician anesthesiologists must use extreme caution when administering narcotics,” said researcher Rajeev Subramanyam, MD. “This study found that combining IV acetaminophen with narcotics relieved pain better, allowing patients to leave the hospital quicker and reduce costs.”

For the study, researchers looked at two groups of tonsillectomy patients—73 children who received intraoperative IV acetaminophen with narcotics and 66 children who received only intraoperative IV narcotics.

Routine use of IV acetaminophen with narcotics resulted in a 3.3% reduction in the number of patients who required additional “rescue” doses of narcotics after surgery, as well as an overall $17.12 savings per patient, according to study authors. The cost reductions, they suggest, were the result of reduced side effects and less time in the recovery room and could lead to potential savings of $9 million per year based on the total number of tonsillectomies done in the U.S.

“In the base case, the IV acetaminophen/opioid combination was both less costly ($49.28) and more effective (3.6% fewer rescue events) in preventing the need for rescue analgesics,” the report concludes. “In sensitivity analyses the IV acetaminophen/opioid combination was always less costly and more effective as long as the need for rescue analgesia in the combination strategy was less than opioids alone. Although the initial medication cost of the combination regimen is more, ultimately it is the least expensive strategy due to reduced side effects and reduced time in the PACU.”

U.S. Pharmacist Social Connect