The efficacy of intravenous paracetamol versus dipyrone for postoperative analgesia after day-case lower abdominal surgery in children with spinal anesthesia: a prospective randomized double-blind placebo-controlled study (original) (raw)
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Journal of Evolution of Medical and Dental Sciences, 2019
Pre-emptive analgesia is administration of an analgesic before a painful stimulus, so as to prevent central sensitisation. Intravenous (IV) formulation of paracetamol has been introduced and its safety and pharmacokinetic properties have been established for children providing excellent analgesia and avoiding side effects associated with opioids and non-steroidal antiinflammatory drugs. Present study was done to compare the analgesic effects of pre-emptive I.V. paracetamol and tramadol in children undergoing lower abdominal surgeries. Sixty-four children of ASA physical status I and II, aged 2 to 12 years scheduled for elective lower abdominal surgeries under general anaesthesia were recruited for a prospective, randomized controlled, double blinded study, into group P and group T. Following induction, group P received 15 mg/ kg I.V. paracetamol and group T 1 mg/kg tramadol in 75 ml of normal saline over 15 minutes before surgical stimulus. Postoperative modified objective pain scale (OPS), time to first rescue analgesia (FRA), Aldrete score, time to reach Aldrete score> 9, sedation scores, parent satisfaction scores and PONV were recorded for 24 hours. Mean pain scores by OPS in group P and T were similar and statistically insignificant. Time to FRA being 320 ± 20 min in group P as compared to group T 340 ± 30 min. 12.5% patients had PONV in group P as compared to 81.5% in group T (p≤0.05). Mean duration to reach Aldrete score of 9 was 11 ± 1.5 min and 16.7 ± 3 min in group P and T respectively (p≤0.05). Pre-emptive I.V. paracetamol is as efficacious as I.V. tramadol for postoperative analgesia with early recovery and lower incidence of PONV in paracetamol group.
Pre-Emptive Analgesia for Postoperative Pain Relief in Children - Role of Paracetamol
2009
The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain of pain and to produce smooth recovery after surgery by decreasing immediate postoperative pain in children by a simple, safe acceptable drug. The children scheduled for tonsillectomy under general anaesthesia were recruited in this study. The analgesic efficiency of rectal paracetamol in two doses, 25 mg/kg bodywt. ) and 50 mg/kg. bodywt. were compared with Diclofenac Sodium suppository 1mg/ kg body weight (Gr-D) given half an hour before induction of anaesthesia. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale). Heart rate and blood pressure were stable in Gr-P 50 and Gr-D. Time of first demand of analgesic was delayed in Gr-P 50 and Gr-D. Total paracetamol consumption in 24 hours was less in and than . Total duration of analgesia in mins. Pre-emptive high dose rectal paracetamol appears to be more effective than diclofenac sodium suppository for postoperative analgesia in children undergoing tonsillectomy.
Journal of the Bangladesh Society of Anaesthesiologists
Background: Pain is a major problem regarding quality of life in children undergoing surgicaloperation.Pain assessment is the most important and critical component of pain management. Oral andrectal paracetamol formulations are associated with a slower onset of action and more variableanalgesic activity than IV acetaminophen, making them less useful in preoperative and acute caresettings. Objective: To find out the effect of intravenous paracetamol in releiving postoperative pain in pediatricpatients. Settings and study design: This randomized clinical trial study was conducted in theAnaesthesiology department of Sir Salimullah Medical College Mitford Hospital,Dhaka fromFebruary' 2014 to August' 2014. A total of 100 cases were taken, they were randomly divided into twogroups in which one group received intravenous paracetamol and another group received diclofenacsuppository for the same operation performed on them, age of the children were between 4-12 years, andall were ASA...
583: Preemptive Analgesia With Ibuprofen and Acetaminophen in Pediatric Lower Abdominal Surgery
Regional Anesthesia and Pain Medicine, 2008
Background: Postoperative pain is a significant problem in pediatrics. Preemptive administration of analgesics has recently emerged as a method to enhance pain management associated with surgery. The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative oral ibuprofen versus acetaminophen in preventing pain after lower abdominal surgery in pediatrics. Methods: In this randomized, double-blind study, following lower abdominal surgery, 75 children, aging 3 to 12 years, were assigned to receive either ibuprofen 20 mg /kg (n=25) or acetaminophen 35 mg/kg (n=25) or placebo (n=25) 2 hours before surgery. Agitation in recovery was measured and postoperative pain was quantified 3 and 24 hours after surgery by Oucher's scale. The amount of postoperative analgesic needed in the ward was also assessed. Results: It was found that preoperative administration of ibuprofen and acetaminophen can reduce agitation in recovery but there was no difference in the agitation score between ibuprofen and acetaminophen groups (P=0.145). Agitation score was significantly lower in ibuprofen group compared to placebo (P>0.005). Similarly, patients in the acetaminophen group were considerably less agitated than those in the placebo group (P=0.002). No significant difference was observed in pain intensity 3 and 24 hours after operation between the three groups [(P=0.495) and (P=0.582) respectively]. The amount of postoperative analgesic needed during ward hospitalization was not significantly different among the three groups (P>0.005). Conclusion: These results provide evidence that preemptive acetaminophen and ibuprofen may reduce agitation during recovery but they neither improve the postoperative pain nor reduce analgesics consumption in ward
Pediatric Anesthesia, 2007
Background: The aim of this study was to investigate whether a supplemental dose of rectal paracetamol at the third or fourth hour would enhance the quality of analgesia provided by caudal epidural blockade in children.Methods: Two hundred and two ASA I patients aged 1–12 years undergoing inguinal surgery were randomized into three groups in the postanesthesia care unit by drawing lots. Patients in the control group did not receive any analgesic until they had a pain score of 5 or higher, patients in the group P3 received rectal paracetamol (20–25 mg·kg−1) at the third hour, and patients in the group P4 received the same dose of rectal paracetamol at the fourth hour after caudal epidural injection. Pain was assessed by VAS (Visual Analog Scale) and supplementary rescue analgesic need was recorded.Results: There was no difference between the demographic data or the duration and variety of surgery among the groups. A significantly lower number of patients required rescue analgesia at the sixth postoperative hour in group P3 and also lower pain scores were again obtained in group P3 at the sixth and eighth postoperative hours.Conclusions: Supplemental rectal paracetamol at the third hour of caudal blockade enhances the quality of postoperative analgesia better than its addition at the fourth hour in children undergoing inguinal surgery.
Pediatric surgery international, 2008
Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Opioids have been used as an analgesic for postoperative pain in children for many years. Tramadol has both opioid and monoaminergic agonist actions. The aim of the study was to determine if the analgesic potency and occurence of adverse effects of tramadol differ from pethidine when administered to children. A total of 110 healthy children, aged 2-12 years, scheduled for elective lower abdominal surgery were randomized to receive either pethidine 1 mg/kg (Group I, n = 60) or tramadol 2 mg/kg (Group II, n = 50) for postoperative pain after anesthesia induction. Pain intensity, adverse effects, heart rate, and systolic and diastolic blood pressure were recorded at regular intervals. The mean pain scores on postoperative 24 h were significantly greater with tramadol than with pethidine. Sedation scores, heart rate and systolic and diastolic blood pressure showed no significant differences betweeen the groups. We conclude that pethidine and tramadol are effective in providing analgesia in pediatric patients, but pethidine provided better postoperative analgesia than tramadol. Changes in blood pressure, heart rate and arterial oxygen saturation were minimal and were similar in both drugs.
Annals of Medical Research, 2019
In our study, we aimed to evaluate retrospectively the efficacy of postoperative analgesia in patients with caudal block versus paracetamol in 67 cases, between the ages of 2-8 years who had undergone elective inguinal hernia and circumcision surgery after induction of general anesthesia. Material and Methods: In this study, we evaluated retrospectively the files of 67 cases between 2-8 years old patients who had caudal block or I.V. paracetamol who undergone inguinal hernia and circumcision operation between September 2017 and September 2018. The files of the cases, anesthesia follow-up forms and nurse observation forms were examined; demographic data, vital signs, duration of surgery, postoperative analgesic requirement and recorded complications were evaluated. Results: The mean age was 3.2±2.35 years in the caudal group and 4.3±2.15 years in the paracetamol group, the mean body weight was 15.1±4.51 kg in the caudal group and 19.4±6.4 in the paracetamol group. The surgical period of patients in the caudal group was 51±12.2 minutes and it was 37.8±15.8 in the paracetamol group. The mean duration of postoperative analgesia was 8.1±1.42 hours in the caudal group and 1.05±1.0 hours in the paracetamol group. There were no complications in any of the patients in the postoperative period. No significant results were found in the vital signs of both groups. While VAS values were statistically significant at 6th and 12th hours, VAS value at 24th hour was not statistically significant. Conclusion: Caudal epidural anesthesia may be a simple and safe method of anesthesia effective in postoperative pain control. May it ensure serious patient comfort with reduced analgesic requirements after surgery. It may be recommended to use pediatric surgery under umbilicus for high success rates and low complication rates.
Journal of Clinical Anesthesia, 2009
Study Objective: To investigate the effect of adding midazolam to continuous epidural infusion of bupivacaine for postoperative analgesia in children. Design: Prospective, randomized, double-blind, controlled study. Setting: Tertiary-care center. Patients: 44 ASA physical status I and II children in age groups of two to 10 years, undergoing elective upper abdominal and flank surgery. Interventions: At the end of surgery, patients were randomly allocated to receive epidural infusion of 0.125% bupivacaine alone (Group B) or with 20 μg/kg/hr midazolam (Group BM) for 12 hours at the rate of 0.2 mL/kg/hr. Measurements: Pain, motor block, and sedation were assessed at predetermined times over 24 hours. Intravenous fentanyl was used as rescue analgesic for the first 12 hours, and tramadol for next 12 hours. Patients were followed at one week, one month, and one year for any neurological deficits. Main Results: The number of patients requiring rescue analgesia during infusion was significantly lower in Group BM (7 vs. 17 in Group B; P b 0.001). Time to first rescue analgesia was significantly prolonged in Group BM compared with Group B (P b 0.001). Frequency of fentanyl (P b 0.001) and tramadol (P = 0.001) administration as rescue analgesia was significantly less in Group BM. Significantly lower median pain scores were obtained in Group BM than Group B at all time intervals (P b 0.05). Greater sedation scores were noted in Group BM at all time intervals postoperatively except ⁎ Corresponding author. at 4 hours (P b 0.05). No motor block was observed in any child during the study. No neurological deficit was reported in any child in the one year of follow-up. Conclusion: Addition of 20 μg/kg/hr of midazolam to postoperative continuous epidural infusion of 0.125% bupivacaine reduces the requirement for rescue analgesia in children following upper abdominal and flank surgery.
Developments in the treatment of postoperative pain in paediatrics
Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.
Pain treatment in children is a rather large and complicated topic, which has recently been further developed and enriched by interesting research studies that have been reported in the medical literature. We therefore decided to restrict this paper to postoperative pain control and the problems related to procedural pain. The undertreatment of children who are in pain following surgery has been recognised. Inadequate treatment of neonates and babies was widespread earlier. However, the 1990s saw a change in physicians' perceptions of neonatal pain and refinement of modern analgesic techniques for use in children . The increased understanding of the neurophysiology of pain and the concept that inadequate treatment of pain can have an impact on outcome and lead to long-term behavioural changes have prompted anaesthetists to study new techniques of pain management in children. In addition, developments are currently in train in clinical pain services, with new, sophisticated analgesia delivery devices and monitoring protocols. A multimodal approach using locoregional anaesthesia combined with opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol is now widely accepted. The emotional component of pain must also be addressed in all aspects of paediatric practice, and it must be recognised that there is a place for instinctive comforting measures, distraction techniques and new nonpharmacological treatments, all of which should be applied to complement safe and effective use of analgesic drugs. Paracetamol is widely used to reduce fever and for analgesia. It acts through inhibition of cyclo-oxygenase and is thought to have an analgesic effect on NMDA receptors in the spinal chord. The pharmacodynamics of paracetamol analgesia have not yet been adequately described in humans, and the therapeutic range for analgesia is not well established. Little or no analgesia is obtained below plasma levels of 10 mg ml -1 . Paediatric studies using paracetamol 10 mg kg -1 orally have shown no Chapter 58