Comparison of Oral Versus Rectal Administration of Acetaminophen With Codeine in Postoperative Pediatric Adenotonsillectomy Patients

Owczarzak, Vicki; Haddad, Joseph

doi:10.1097/01.mlg.0000227530.64179.1f

Cited by 19 publications

(18 citation statements)

References 12 publications

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“…[4] Rectal suppositories achieved equivalent pain control as oral medication with few side-effects and good tolerance. [12] Rectal acetaminophen 40 mg/kg is effective in reducing pain and postoperative analgesic requirement after tonsillectomy. [13]…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery

Gandhi

Sunder

2012

J Anaesthesiol Clin Pharmacol

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Background:Analgesic efficacy of rectal acetaminophen is variable in different surgical procedures. Little data is available on its efficacy in ophthalmic surgeries. We conducted this prospective, randomized, double blind study to evaluate and compare the efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery over a 24 hour period.Materials and Methods:135 children scheduled for elective ophthalmic surgery were randomly allocated to one of the three groups, high, low, or control (H, L, or N) and received rectal acetaminophen 40 mg/kg, 20 mg/kg or no rectal drug respectively after induction of general anesthesia. Postoperative observations included recovery score, hourly observational pain score (OPS) up to 8 hours, time to first analgesic demand, and requirement of rescue analgesics and antiemetics over a 24 hour period.Results:Nineteen of 30 (63%) of children in group N required postoperative rescue analgesic versus 5/48 (10%) of group H (P <0.0001) and 10/47 (23%) of group L (P =0.0005) during 24 hour period. Mean time to requirement of first analgesic was 206±185 min in group H, 189±203min in group L, and 196 ±170 min in group N (P=0.985). OPS was significantly lower in group H and L compared to group N during first 8 hours. Requirement of rescue antiemetic was 18.7% in group H as compared to 23% each in group L and group N (P >0.5).Conclusions:Single dose rectal acetaminophen can provide effective postoperative analgesia for pediatric ophthalmic surgery at both high dose (40 mg/kg) and low dose (20 mg/kg) both in early postoperative and over a 24 hour period.

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Section: Discussionmentioning

confidence: 99%

Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery

Gandhi

Sunder

2012

J Anaesthesiol Clin Pharmacol

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“…Improved documentation can result in improved pain management (22)(23)(24)(25). Studies demonstrate that there is low utilization of pain tools and policies (26) and that pain is under-assessed (3,27) and poorly documented (28,29), resulting in children being under-medicated and/or their pain being poorly managed (3,27,(30)(31)(32). Regular pain evaluation can contribute to the safety and efficacy of the management of acute pain (33).…”

Section: Evidencementioning

confidence: 99%

“…Further advice for use in specific age-groups, and specifically for some of the most common procedures, is described in sections 4.2 and 4.3. Nonpharmacological measures including tactile stimulation, breast-feeding, non-nutritive sucking, 'kangaroo care', and massage of the heel can be used for heel prick blood sampling: Grade A (12,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)30).…”

Section: General Considerationsmentioning

confidence: 99%

“…Relieving the pain of HPBS has been challenging with pharmacological methods. However, nonpharmacological methods including breast-feeding, non-nutritive sucking, kangaroo care, and premassage of the heel before and during HPBS have consistently demonstrated reduced behavioral pain scores and physiological markers (12,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Evidencementioning

confidence: 99%

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Good Practice in Postoperative and Procedural Pain Management, 2nd Edition

2012

Pediatric Anesthesia

124

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Pe d iatric Ane sth e sia is ind e xe d in Ind e x Me d icus, MEDLINE, Curre nt Co nte nts/Clinical Me d icine , EMBASE/ Exce rp ta Me d ica, Sci Se arch , Re se arch Ale rt, Ad Re f e re nd um Anae sth e sio lo gy, SUBIS and Curre nt Op inio n in Anae sth e sio lo gy Pediatric Anesthesia Volume 22 Supplement 1 July 2012 that the relationship is causal 2+ Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal 2) Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal 3 Non-analytic studies, e.g. case reports, case series 4 Expert opinion 2

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“…Adenotonsillectomy is the most frequent ENT operation performed in children. Pain is an unpleasant subjective sensation which can only be experienced, so it is extremely difficult to be expressed in children who depend on their parents or care providers for their well-being (Owezarzak and Haddad 2006). Post-tonsillectomy pain needs special extra care and control as it may affect child's ability to tolerate oral pain medication and fluid intake, resulting in nausea, vomiting, and or more serious dehydration (Pickering et al 2002).…”

Section: Introductionmentioning

confidence: 99%

The prophylactic effect of rectal diclofenac versus intravenous pethidine on postoperative pain after tonsillectomy in children

Saleh

Hassan

2019

Ain-Shams J Anesthesiol

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Background: Postoperative pain in children is common after tonsillectomy. Rectal diclofenac has been used effectively for postoperative pain management in small children. Aim: To evaluate the prophylactic effect of rectal diclofenac versus intravenous pethidine on postoperative pain management in children undergoing tonsillectomy. Methods: This was a prospective, double-blinded randomized study. A total of 100 children, aged 3-10 years, American Society of Anesthesiologists status I or II, and scheduled for elective tonsillectomy or adenotonsillectomy, were recruited for the study. Patients were randomized to receive either rectal diclofenac 2 mg/kg (group A) or intravenous pethidine 0.5 mg/kg (group B) after induction of general anesthesia. The postoperative pain was assessed using Face, Legs, Activity, Cry, and Consolability scale for the first 6 h. The need for rescue analgesic, rectal paracetamol 40-60 mg/kg, was recorded also after surgery. Moreover, estimation of sedation using Ramsay sedation scale was assessed. Postoperative complications considering mainly vomiting and respiratory depression were recorded. Data were statistically described in terms of mean ± SD, median and range, or frequencies (number of cases) and percentages when appropriate. Results: Pain scores were significantly lower in diclofenac group at different times and needed less rescue analgesic. Postoperative sedation and vomiting were significantly higher in pethidine group. Respiratory depression occurred only in pethidine group. Conclusion: Prophylactic rectal diclofenac is effective in reducing pain after adenotonsillectomy and postoperative analgesic requirement. Moreover, it is generally safe.

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Comparison of Oral Versus Rectal Administration of Acetaminophen With Codeine in Postoperative Pediatric Adenotonsillectomy Patients

Cited by 19 publications

References 12 publications

Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery

Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery

Good Practice in Postoperative and Procedural Pain Management, 2nd Edition

The prophylactic effect of rectal diclofenac versus intravenous pethidine on postoperative pain after tonsillectomy in children

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