Scheduled perioperative intravenous acetaminophen reduces opioid usage in the postoperative period for neonates undergoing gastrointestinal surgery
In brief
Neonatal surgery patients used two-thirds less opioid with IV acetaminophen
In a matched study of 82 neonates having gastrointestinal surgery, those given scheduled intravenous acetaminophen used a median of 0.6 mg/kg of opioid in the first 48 hours, versus 1.8 mg/kg with standard care. Pain scores were similar, but historical controls and non-significant trends in recovery outcomes leave the effects on broader recovery uncertain.
- Journal
- Surgery (Q1)
- Published
- 10 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Gemma Barber, Abbey Arnott, Jacob Davidson, Claire Parent, Emily Walser, Kelly Mendham, et al.
- PMID
- 42976579
- DOI
- 10.1016/j.surg.2026.110748
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 8 November 2026): Neonatal gastrointestinal surgery analgesia; reduces postoperative opioid use
Abstract
BACKGROUND: Multimodal analgesia is recommended by Enhanced Recovery After Surgery guidelines for the pediatric population to prevent deleterious effects of opioids. Acetaminophen offers an effective alternative, and intravenous delivery is the most reliable option. Thus, we implemented a perioperative intravenous acetaminophen protocol for neonates undergoing gastrointestinal surgery to reduce postoperative opioid utilization. METHODS: A matched, observational cohort study design was utilized. The intervention group received intravenous acetaminophen dosed by weight once preoperatively and at regular intervals postoperatively. Propensity score matching compared the intervention group to historical controls of neonatal gastrointestinal surgery cases that received standard postoperative analgesic care. The primary outcome measure was cumulative postoperative opioid use within 48 hours after surgery in total morphine milligram equivalents per kilogram. Other outcomes included pain score via the Neonatal Pain, Agitation, and Sedation Score, postoperative length of hospital stay, postoperative days to extubation, time to first enteral feed, time on parenteral nutrition, and adverse events. RESULTS: There were 82 cases included, 41 intervention and 41 control. There was a significant reduction in median morphine milligram equivalents per kilogram in the intervention group (0.6; interquartile range, 0.0-2.6 vs 1.8; interquartile range, 0.7-14.4; P = .0187). Median Neonatal Pain, Agitation, and Sedation Score at 48 hours postoperatively was equivalent between groups (2.6; interquartile range, 1.3-3.6 vs 2.3; interquartile range, 1.3-3.3; P = .8239). There were trends toward decreased duration of intubation and time on parenteral nutrition. CONCLUSION: Intravenous acetaminophen is effective in reducing opioid use while maintaining adequate analgesia in neonates who have undergone gastrointestinal surgery. This intervention may improve overall outcomes for this population.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.