Intravenous Acetaminophen for Postoperative Pain in Neonates: A Multi-Methods Approach

Abstract

Background: Managing pain is challenging, especially in neonates. Uncontrolled pain and opioid exposure are associated with short- and long-term adverse events. Adequately controlling pain while reducing opioid exposure is paramount in the neonatal population. This thesis presents three studies, all aiming to determine if IV acetaminophen is an appropriate adjunct to current opioid-based postoperative pain regimens. The population of interest is neonates admitted to the neonatal intensive care unit (NICU) treated with major abdominal and thoracic surgery. Chapter 1 provides the scientific framework underpinning this work and the rationale for performing the included studies. Chapter 2 presents the results of a systematic review and meta-analysis assessing the effect of IV acetaminophen on postoperative pain in pediatric patients. This chapter further expands on gaps and opportunities for future research. Chapter 3 reports the results of a national survey in which pediatric surgeons, anesthesiologists, and neonatologists reported their postoperative pain prescribing practices in the NICU and their perspectives on the use of IV acetaminophen. Chapter 4 describes the protocol for a pilot randomized controlled trial (RCT). This study will assess the feasibility of a multicenter RCT to evaluate the effectiveness of IV acetaminophen for postoperative pain in neonates recovering from major abdominal and thoracic surgery. Chapter 5 summarizes the results of the studies in context and details how the results of each study informed the others. It also discusses areas of future research.