American Academy of Pediatrics – Section on Surgery

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November 4, 2019

Reduce post-operative opioid requirements in pediatric patients by administering acetaminophen and/or non-steroidal anti-inflammatory medications in the perioperative period.


Multi-modal analgesia is recommended in the management of children for their perioperative pain. Significant decreases in opioid consumption can be achieved with the concurrent use of non-steroidal anti-inflammatory drugs (NSAID) and/or acetaminophen in infants and children undergoing surgery of moderate or major severity, especially within the first twenty-four hours following surgery. The use of NSAIDs during the first 24-hours of post-operative care also reduced the incidence of nausea and vomiting.

In addition to decreasing the possibility of narcotic dependence, avoidance of opioids confers added benefits of reducing the incidence of post-operative nausea and constipation and aiding in early ambulation.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

Members of the American Academy of Pediatrics Section on Surgery Subcommittee on Education and Delivery of Surgical Care submitted the top 5 topics for Choosing Wisely items based on a review of the literature and expert opinion. The items were refined, ranked and approved by the Section on Surgery leadership. The list was then reviewed and approved by more than a dozen relevant AAP Committees, Councils and Sections. The AAP Executive Committee granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


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Michelet D, Andreu-Gallien J, et al. A meta-analysis of use of nonsteroidal anti-inflammatory drugs for pediatric postoperative pain.  Anesthesia Analgesia 114 (2012) 393-406.

Brasher C, Gafsous B, et al. Postoperative pain management in children and infants: An update. Pediatric Drugs 16 (2014) 129-140.

Ceelie I, de Wildt SN, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery. JAMA 309 (2013) 149-154.