Analgesic effectiveness of acetaminophen for primary cleft palate repair in young children: A randomized placebo controlled trial

Chelan Nour, Joanna Ratsiu, Neeta Singh, Linda Mason, Andrea Ray, Mark Martin, Mohammad Hassanian, Jacob Uhler, Richard Lee Applegate

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background Clefting of the lip, palate, or both is a common congenital abnormality. Inadequate treatment for pain in children may result from concerns over opioid-related adverse effects. Providing adequate pain control with minimal adverse effects remains challenging in children. Objectives To assess opioid-sparing effects of oral or intravenous acetaminophen following primary cleft palate repair in children. Methods Prospective randomized controlled trial in 45 healthy children, ages 5 months to 5 years, using standardized general anesthesia and lidocaine infiltration of the operative field. Patients were allocated to groups: intravenous acetaminophen/oral placebo (intravenous), oral acetaminophen/intravenous placebo (oral), or intravenous/oral placebo (control). Groups were compared for differences in opioid administration during the 24-h study period (morphine equivalents μg·kg-1; 95% confidence interval). Results Intravenous acetaminophen decreased opioid requirement after surgery (P = 0.003). Patients in the intravenous group received less opioid (272.9; 202.9-342.8 μg·kg-1) than control patients (454.2; 384.3-524.2 μg·kg-1; P < 0.002). Opioid requirement in oral patients (376.5; 304.1-448.9 μg·kg-1) was intermediate and not significantly different from either intravenous (P = 0.11) or control (P = 0.27). During the ward phase of care, intravenous had better analgesia than control (P = 0.002), and both intravenous and oral group patients received less opioid than control (P = 0.01). Conclusion Intravenous acetaminophen given to young children undergoing primary cleft palate repair was associated with opioid-sparing effects compared to placebo. The fewer morphine doses during ward stay in both intravenous and oral may be important clinically in some settings.

Original languageEnglish (US)
Pages (from-to)574-581
Number of pages8
JournalPaediatric Anaesthesia
Issue number6
StatePublished - 2014
Externally publishedYes


  • acetaminophen
  • cleft palate
  • congenital abnormalities and syndromes
  • pain miscellaneous
  • pain PACU

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)


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