Analgesic Efficacy of Intravenous Versus Rectal Acetaminophen After Adeno Tonsillectomy in Children

Background:Effective pain relief therapy after caesarean section is essential for the parturient's comfort and early ambulation. Paracetamol has an excellent safety profile when compared to opioids.Aim:To assess and evaluate the effect of oral, rectal, and intravenous infusion of paracetamol for post-operative analgesia in women undergoing caesarean section under spinal anaesthesia.Settings and Design:We conducted a prospective, randomized controlled study (18-35 years of age) of the ASA- I and II parturient scheduled for lower segment caesarean section were included.Methods and Materials:They were randomly allocated to 3 groups of 50 each. Group A received oral paracetamol tablet 650mg (1 tablet) 20min before shifting to operation room, group B received rectal paracetamol suppository 35-45 mg/kg immediately after spinal anaesthesia and group C received i.v. paracetamol infusion of 10-15mg/kg over 15min duration 20min before finishing the operation. Duration of analgesia was evaluated as primary outcome and other parameters as secondary outcome.Statistical Tests:All statistical analyses were performed using the SPSS statistical package 17.0 version. Results were analyzed using Chi Square test for non-parametric data and ANOVA for parametric data. P value of less than 0.05 was considered significant and less than 0.001 as highly significant.Results:Duration of analgesia was significantly longer in group B as compared to group A and C. The requirement of supplemental rescue analgesia was also lower in group B compared to group A and C. No significant haemodynamic derangements and adverse effects were noted among all the three groups.Conclusion:Paracetamol when given rectally improves the quality and duration of postoperative analgesia to a greater extent as compared to oral and intravenous route of paracetamol without any side effects.

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“…Mostly, studies conducted are on children due to better acceptability of rectal route versus parenteral or IV route. [ 5 6 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…in 2015 concluded that time to first rescue analgesia was significantly longer in children receiving rectal acetaminophen (8.96 ± 3.46 h) compared with those receiving IV acetaminophen (6.00 ± 1.63 h). [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Study to compare the effect of oral, rectal, and intravenous infusion of paracetamol for postoperative analgesia in women undergoing cesarean section under spinal anesthesia

et al. 2017

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“…In conjunction with a study by Beltramini et al ,[ 10 ] the therapeutic threshold for CHIPPS score was considered as 4 or more and for VAS was 4. [ 11 ]…”

Section: Methodsmentioning

confidence: 99%

Infraclavicular block in children: Is blocking lateral or posterior cord equally successful?

Ponde,

Puri,

Desai

et al. 2022

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: The most effective approach for infraclavicular brachial plexus block in adults is to target the posterior cord, usually situated posterior to axillary artery. However, we do not know if this can be extrapolated in children. Our primary objective was to compare the clinical success rate of ultrasound guided infraclavicular brachial plexus block in children with local anesthetic injection aimed at two targets. These were posterior to axillary artery (posterior cord) and lateral to axillary artery (lateral cord). The secondary objectives involved need for intraoperative rescue analgesia, evaluation of duration of analgesia, incidence of complications such as pneumothorax and arterial puncture, comparison of postoperative pain scores and fluoroscopic dye spread pattern was also observed. Material and Methods: It was a randomized, prospective pilot study. Forty children undergoing forearm and hand surgeries were randomized to two groups, in accordance with the target site of the block. Target sites of Group P (20 patients) and Group L (20 patients) were posterior and lateral to the axillary artery, i.e., posterior and lateral cord respectively. Aforesaid objectives were assessed. SPSS (Version 15.0) statistical package was used. Comparison between Group L and P was by using student’s unpaired t test for age and weight. Fisher’s exact probability test was applied to compare percentages between groups. Results: Blocks of both groups were equally successful. No patient required intraoperative rescue analgesia. Duration of analgesia was comparable. Both groups had no major complications and similar postoperative pain scores. Conclusions: The success rate of infraclavicular brachial plexus block by aiming at the lateral and posterior cord was similar.

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Efficacy of different routes of acetaminophen administration for postoperative pain in children: a systematic review and network meta-analysis

Osorio,

Maldonado,

Rijs

et al. 2024

Can J Anesth/J Can Anesth

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Purpose Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population. Methods We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30 days and 17 yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales. Results We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous vs rectal routes of administration of acetaminophen (difference in means, −0.28; 95% confidence interval [CI], −0.62 to 0.06; very low certainty of the evidence) and intravenous vs oral acetaminophen (difference in means, −0.60; 95% CI, −1.20 to 0.01; low certainty of the evidence). For the comparison of oral vs rectal routes, we found evidence favouring the oral route (difference in means, −0.88; 95% CI, −1.44 to −0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78). Conclusion The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question. Study registration PROSPERO (CRD42021286495); first submitted 19 November 2021. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-024-02760-y.

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Analgesic Efficacy of Intravenous Versus Rectal Acetaminophen After Adeno Tonsillectomy in Children

Cited by 5 publications

References 23 publications

Study to compare the effect of oral, rectal, and intravenous infusion of paracetamol for postoperative analgesia in women undergoing cesarean section under spinal anesthesia

Study to compare the effect of oral, rectal, and intravenous infusion of paracetamol for postoperative analgesia in women undergoing cesarean section under spinal anesthesia

Infraclavicular block in children: Is blocking lateral or posterior cord equally successful?

Efficacy of different routes of acetaminophen administration for postoperative pain in children: a systematic review and network meta-analysis

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