Acute pain management: acetaminophen and ibuprofen are often under-dosed

Abstract

Agenzia Italiana del Farmaco-Observational Study Register (RSO). Registration code: PIERRE/1 What is Known: • Pain is frequent in children presented to emergency department. • International recommendations on pain management are often not implemented. What is New: • Acetaminophen and ibuprofen were frequently underdosed in children prescribed for pain in the Italian emergency departments. • Under-dosage may be related to the habit of using acetaminophen and ibuprofen in the recommended range for fever treatment.

Multicentre emergency department study found that paracetamol and ibuprofen were inappropriately used in 83% and 63% of paediatric cases

“…However, our data show that inappropriate doses were significantly more frequent in younger children who tend to receive drops and syrup formulations that are easier to adjust based on the patient's weight, than items such as tablets. These aspects were also reported by Milani et al (25), who stated that 61% of children presenting with pain to Italian EDs received less than the required dose of analgesics, namely paracetamol and ibuprofen. In that study, the under dosage was correlated to the use of suppositories and lower and higher body weight and the use of ibuprofen was associated with under dosage (25).…”

“…These aspects were also reported by Milani et al (25), who stated that 61% of children presenting with pain to Italian EDs received less than the required dose of analgesics, namely paracetamol and ibuprofen. In that study, the under dosage was correlated to the use of suppositories and lower and higher body weight and the use of ibuprofen was associated with under dosage (25). Furthermore, some analgesic drugs are prescribed off-label in certain situations.…”

Empfehlungen zur Verwendung von Opioiden bei Kindern während der perioperativen Versorgung

“…Gerade Paracetamol und Ibuprofen werden oft zu niedrig dosiert [19], und besonders durch die Kombination beider Substanzen sind mit zunehmender Evidenz sehr gute Effekte zu erzielen [20 -23].…”

“…B. bis 0,35 µg/kg/ min) die Spontanatmung erhalten bleibt [31] Zur PCA sollte eine feste Verordnung von Nichtopioid-Analgetika erfolgen. Zwar wird Paracetamol oft zu niedrig dosiert [19], zusätzlich ist seine therapeutische Breite aber gering und vergleichsweise geringe Überdosierungen bergen die Gefahr eines lebensbedrohlichen Leberversagens [37]. Besonders effektiv scheint eine Kombination mit Ibuprofen zu sein [20 -23].…”

Comparison of intravenous Acetaminophen and Morphine Sulfate for abdominal pain management in patients with acute abdomen

“…Pain sedation of patients with acute abdomen is an important matter. 2 but since the physical examination has an important role in diagnosis of acute abdomen with peritonitis symptoms such as Tenderness and rebound Tenderness, the admission of routine analgesics for pain sedation of these patients, may mask the symptoms and is not suggested in physical examination. Recent studies unlike previous hypothesis have proven the pain that the admission of intravenous opioids has no effect on therapeutic procedure and only decreases the pain in this patients.…”