A bold takeaway reveals a quiet revolution in pediatric care and sustainability: a common analgesic isn’t just easing young patients’ pain, it’s also sparing the planet and conserving NHS resources. Yet this isn’t without controversy—some may question whether oral dosing is truly as effective as intravenous delivery in every scenario. Here’s how Swansea Bay clinicians are reshaping practice, with clear implications for families and hospital budgets alike.
Five clinicians from Swansea Bay spearheaded a project examining how paracetamol is administered to children undergoing planned surgery at Morriston Hospital. Traditionally, paediatric patients under general anaesthesia received paracetamol via intravenous infusion through a cannula in the hand. The new approach shifts toward giving oral paracetamol—either liquid or tablet form—before the child is anaesthetised and taken to theatre.
The project’s results show that oral paracetamol provides the same level of analgesia as the IV option once the child awakens from surgery. More notably, it delivers substantial savings on costs and imposes a far smaller environmental footprint.
The shift to oral dosing is driven by two key advantages. First, the purchase and administration costs of oral paracetamol are minimal—paracetamol tablets and suspensions are inexpensive to produce and stock. Second, the environmental impact of manufacturing, distributing, and delivering IV paracetamol is considerably higher. In fact, the team’s analysis indicates that avoiding IV paracetamol for paediatric planned surgery could prevent the equivalent of over 23,000 miles of driving in a year.
The IMPROVE project—Improving Paracetamol use with Routine Oral over Venous administration—was led by Consultant Anaesthetists Tereza Soskova and Rebeca Harris, with Alex Morgan, Senior Clinical Fellow Lara Sabry, and Core Trainee Linn Jarte contributing. Dr. Soskova explained that there is no difference in safety or analgesic efficacy between IV and oral paracetamol from the patient’s perspective. She highlighted compelling figures: oral paracetamol saves about 98.3% in costs, and internal calculations initially estimated IV paracetamol to be roughly 24 times more expensive than its oral counterpart.
Environmental considerations are equally striking. IV paracetamol can generate up to 12 times higher carbon emissions than oral formulations. These findings have prompted a strategic shift toward predominantly oral use, with the team aiming for a target of around 90% oral administration.
During 2024, more than 90% of paracetamol given to over 1,300 paediatric patients was delivered intravenously. If oral dosing had been used instead, the project estimates a reduction of about 9,190 kilograms of effective carbon dioxide (eCO2), equivalent to driving roughly 23,403 miles in a petrol-powered car. Financially, relying on IV administration cost about £1,150 more over the period studied.
Supporting this initiative, a British Journal of Anaesthesia paper published last year examined the environmental and financial impacts of perioperative paracetamol usage, underscoring that healthcare accounts for about five percent of global greenhouse gas emissions, with pharmaceuticals contributing 19–32 percent of that share. Paracetamol itself ranks among the most widely used drugs, comprising around six percent of worldwide pharmaceutical sales. The Swansea Bay team used these broader insights to gauge their own impact and drive change.
Building on these successes, the project is set to scale up, extending the oral-first approach to planned adult surgeries across Morriston, Singleton, and Neath Port Talbot hospitals. The larger patient volumes there promise even greater opportunities to save both money and environmental resources while maintaining high-quality patient care.
