Acetaminophen's Efficacy for Post-operative Pain Control

• Post-operative FLACC: Face, Legs, Activity, Cry & Consolability (FLACC) pain assessment scores. [ Time Frame: Admission into PACU and every 10 minutes until hospital discharge, between 1 - 2 hours. At the conclusion of enrollment, this measure will be assessed for all participants. ] [ Designated as safety issue: No ]
• Incidence of post-operative vomiting [ Time Frame: From admission into PACU until 24 hours post-hospital discharge. At the conclusion of enrollment, this measure will be assessed for all participants. ] [ Designated as safety issue: No ]
• Parental satisfaction with pain control, as measured by a 10 point Likert scale. [ Time Frame: Telephone call to parents at 24 hours post hospital discharge. At the conclusion of enrollment, this measure will be assessed for all participants. ] [ Designated as safety issue: No ]

The purpose of this study is to compare IV acetaminophen to oral acetaminophen for pain control in children undergoing tonsillectomy with or without adenoidectomy.

Tonsillectomy with or without adenoidectomy is a common surgical procedure in children and adolescents. Usually performed for recurrent tonsillitis or symptoms of airway obstruction, the procedure can result in significant post-operative pain. Common analgesic techniques include the use of oral acetaminophen, non-steroidal anti-inflammatory drugs (ibuprofen PO or ketorolac IV), and narcotics. Acetaminophen has been shown to be effective in reducing pain and post-operative opioid requirements. Its administration can be oral, rectal, or intravenous. NSAIDs, though effective for pain control, have been shown to increase bleeding risk and disrupt hemostasis. Narcotics are effective for pain control but increase the risk of nausea and vomiting. They also have the potential to cause respiratory depression.

IV acetaminophen (OFIRMEV) is indicated for management of mild to moderate pain, and as an adjunct to opioids for severe pain. Several studies have examined the efficacy of IV acetaminophen vs placebo and/or active controls (meperidine, rectal acetaminophen (PR), tramadol). IV acetaminophen has been shown to be superior to placebo for pain control. Though there is data regarding peak plasma and CSF concentration of acetaminophen when given by different routes (PO vs IV vs PR), there is no data comparing the efficacy of oral vs IV administration for pain control post-tonsillectomy in children.

• Tonsillitis
• Airway Obstruction
• Difficulty Swallowing

• Drug: IV acetaminophen
  IV acetaminophen 15 mg/kg (up to 1000 mg) over 15 minute infusion after IV placement in OR in study group only.
• Drug: PO acetaminophen
  PO acetaminophen elixir 15 mg/kg (up to 1000 mg) administered approximately 90 minutes prior to induction of anesthesia in the pre-operative area.

• Experimental: Study Group
  IV acetaminophen 15 mg/kg (up to 1000 mg) administered intraoperatively over a 15 minute infusion.
  Intervention: Drug: IV acetaminophen
• Active Comparator: Control Group
  PO acetaminophen elixir 15 mg/kg (up to 1000 mg) administered approximately 90 minutes prior to induction of anesthesia in the pre-operative area.
  Intervention: Drug: PO acetaminophen

Inclusion Criteria:

• Children 5-13 years of age
• Surgical procedure: tonsillectomy with or without adenoidectomy
• American Society of Anesthesiologists physical status classification 1 and 2 (patients that have either no systemic illness or mild systemic disease that is well-controlled, e.g. mild asthma)

Exclusion Criteria:

• Known allergy to study medication(s)
• Known genetic abnormality
• Known hepatitis
• Children with other physical, mental or medical conditions which, in the opinion of the PI, make study participation inadvisable or impairs pain assessment
• Children who have taken any analgesic within 24 hours prior to surgery
• Enrollment in concurrent research study
• Pregnant patients*
• Students/trainees/staff*
• Mentally disabled/cognitively impaired*