A multicenter, randomized, double‐blind placebo‐controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy

Abstract

Summary Background Tonsillectomy is one of the most common pediatric procedures in the United States. An optimal perioperative pain control regimen remains a challenge. Intravenous ibuprofen administered at induction of anesthesia may be a safe and efficacious option for postoperative tonsillectomy pain. Objectives To determine whether preoperative administration of intravenous ibuprofen (IV‐ibuprofen) can significantly decrease the number of doses of postoperative fentanyl when compared with placebo in pediatric tonsillectomy surgical patients. Methods This was a multicenter, randomized, double‐blind placebo‐controlled trial conducted at six hospitals in the United States. A total of 161 pediatric patients aged 6–17 years undergoing tonsillectomy were randomized to receive either a single preoperative dose of 10 mg·kg−1 IV‐ibuprofen or placebo (normal saline). Postoperative pain was managed with intravenous fentanyl (0.5 μg·kg−1) on an as needed basis when the visual analog scale (VAS) was >30 mm and deemed appropriate by recovery room nurse/physician. The primary endpoint was the number of doses and amount of postoperative fentanyl administered postoperatively for rescue analgesia. Results There was a significant reduction in the number of postoperative doses and the amount of fentanyl administered after surgery in the IV‐ibuprofen group compared with the placebo group (P = 0.021). There were no differences in the time to first analgesia request or the number of patients who required postoperative analgesia. There were no significant differences in the incidence of serious adverse events, surgical blood loss (P = 0.662), incidence of postoperative bleeding, or a need for surgical re‐exploration between the treatment groups. Conclusion Administration of IV‐ibuprofen, 10 mg·kg−1, significantly reduced fentanyl use in pediatric tonsillectomy patients.

Double-Blind Randomized Placebo-Controlled Trial of Single-Dose Intravenous Acetaminophen for Pain Associated With Adenotonsillectomy in Pediatric Patients With Sleep-Disordered Breathing

“…Although previous studies have reported adequate analgesia with lower intraoperative doses of morphine, with the use of shorter-acting analgesics such as fentanyl in combination with nonopioid analgesics, the longer-acting agent morphine, when administered in appropriate doses with appropriate postoperative monitoring, offers the benefit of providing analgesia beyond the immediate recovery time in the PACU. 20,22,23 In these subjects, the average time to the first request for an additional analgesic agent was 4 to 5 hours after admission to the inpatient ward. Although decreasing the morphine dose could highlight an opioid-sparing effect of the intravenous acetaminophen in the immediate PACU period, it may also lead to rebound postoperative pain.…”

Anesthetic Management of Endoscopic Endonasal Surgeries in Pediatric Oncology

“…Такие препараты обладают не только мощным противовоспалительным действием, но и обеспечивают упреждающую анальгезию, если применяются до разреза. НПВС противопоказаны у пациентов с бронхиальной астмой, поливален-тными аллергиями, гастропатиями [13].…”

“…Применение упреждающей (преэмптивной) анальгезии (введение НПВС: у детей старшего возраста -кетопрофен в дозе 2 мг/кг, у детей младшего возраста -парацетамол в дозе 15 мг/ кг) и инфильтрационной анестезии позволяет снизить опиоидную нагрузку в периоперацион-ный период [18]. Согласно современным дан-ным, однократное внутривенное введение НПВС в стандартной дозировке при ЛОР-операциях характеризуется безопасным профилем и не при-водит к увеличению времени кровотечения [13]. По данным ряда исследований, внутривенное введение 1 дозы НПВС или парацетамола сни-жает опиоидную нагрузку в ранний послеопера-ционный период, а также частоту возникновения послеоперационных тошноты/рвоты и после-операционного делирия [17,19,20].…”

Ibuprofeno intravenoso: experiencia clínica en el tratamiento del dolor postoperatorio

“…Entre las 0-48 horas y 24-48 horas post alta hospitalaria, el grupo de pacientes tratados con ibuprofeno i.v. presentó significativamente menor emesis que el grupo control (23).…”