Abstract 16323: Association Between Intravenous Acetaminophen and Opioid Use in Postoperative Management of Patients Following Congenital Heart Defect Repair

IntroductionAcetaminophen (APAP) possesses highly selective analgesic and antipyretic effects resulting from its inhibitory actions on the synthesis of prostaglandins. The relationship between postoperative intravenous (IV) APAP and narcotic use in patients with congenital heart disease is largely undefined.HypothesisAdministration of IV APAP postoperatively in patients with Tetralogy of Fallot (TOF), VSD, and ASD is associated with a decreased use of opioids, benzodiazepines and other pain medications in the cardiac intensive care unit (CICU).MethodsThe study was approved by the Institutional Review Board. A retrospective chart review was conducted between January 1, 2013 to January 1, 2018. Patients were included if they were admitted to the CICU after undergoing surgical repair of TOF, atrial or ventricular septal defect. Patients with severe hepatic dysfunction, severe developmental delay, Autism Spectrum Disorder, Trisomy 21 and allergy to APAP were excluded. Patients who received IV APAP received a standard dose (10-15mg/kg up to 1000 mg/dose) scheduled every 6 hours for 48 hours. The control group did not receive IV APAP. The following data was collectedpatient demographics, liver enzymes, serum total bilirubin, time to extubation, length of stay in CICU, pain/sedation scores and administration of IV APAP postoperatively. The total dose (mg/kg) for opioids, benzodiazepine, and NSAIDs administered was obtained for both the first 48 hours in the CICU and during the entire length of stay in the CICU.ResultsA total of 146 patients met inclusion criteria of which 37 patients received post-operative IV APAP. Patients who were treated with IV APAP within the first 48 hours after surgery received less morphine than patients who were not treated with IV APAP (0.35 mg/kg vs 0.51 mg/kg) (p