Diclofenac for acute pain in children

Standing, Joseph F.; Savage, Imogen; Pritchard, Deborah; Waddington, Marina

doi:10.1002/14651858.cd005538.pub2

Cited by 20 publications

(13 citation statements)

References 119 publications

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“…A major conclusion of a recent Cochrane systematic literature review (7) was that a fivefold dose range was seen in pediatric clinical studies and that adequate dosing information was lacking. A pharmacokinetic model that simultaneously fits all formulations suitable for acute pain in children has been developed, allowing for dosing recommendations to be made based on the known pharmacodynamics in adults (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…Eligible studies were identified during a Cochrane systematic literature review on diclofenac for acute pain in children (7). The authors of all studies that mentioned diclofenac concentration measurement were contacted and asked to provide raw data for a pooled analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Diclofenac has been widely studied for acute pain in children, and found to be effective, cause less nausea and vomiting than opiates, and has a low incidence of adverse effects (7). It is commonly used for acute pain in children (8), but dosing guidelines are lacking; there is a fivefold range (0.5–2.5 mg·kg −1 ) over which diclofenac is dosed in pediatric clinical studies (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Diclofenac pharmacokinetic meta‐analysis and dose recommendations for surgical pain in children aged 1–12 years

Standing

Tibboel

Korpela

et al. 2011

Pediatric Anesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diclofenac pharmacokinetic meta‐analysis and dose recommendations for surgical pain in children aged 1–12 years

Standing

Tibboel

Korpela

et al. 2011

Pediatric Anesthesia

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“…Pain assessment was performed by a different score system; however, the pain threshold could be considered to be equivalent according to a recent Cochrane review. 7 …”

Section: Methodsmentioning

confidence: 99%

Clonidine versus other adjuncts added to local anesthetics for pediatric neuraxial blocks: a systematic review and meta-analysis

Yang¹,

Yu²,

Zhang³

2018

JPR

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BackgroundClonidine is a common adjunct to local anesthetics for pediatric neuraxial block; however, the pros and cons between clonidine and other adjuncts remain unclear. Thus, we performed this meta-analysis of randomized controlled trials to assess the efficacy and adverse effects between clonidine and other adjuncts added to local anesthetics.Materials and methodsThe systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Randomized controlled studies were searched in Cochrane (to present), Medline (1946 to present), Embase (1974 to present), and Biosis (1995 to present). Relative risks (RRs), standard mean difference (SMD), and associated CIs were calculated using RevMan statistical software to assess continuous and dichotomous data. Heterogeneity in studies was measured by forest plots and I2 values. Subgroup analysis was performed for continuous and dichotomous variables, while meta-regression was applied for continuous data with high I2 values.ResultsA total of 15 randomized controlled studies met the inclusion criteria. There was a longer duration of postoperative analgesia in the clonidine group than for other adjuncts (SMD=1.54, p=0.005, I2=96%). The number of patients requiring rescue analgesia was lower in the clonidine group without the addition of epinephrine (RR=0.55, p=0.0002, I2=0), while the RR for the comparison with epinephrine was significant (p=0.62, I2=95%). The duration of motor block was longer in the clonidine group (mean difference [MD]=1.06, p<0.00001, I2=0). The clonidine group also had a lower incidence of postoperative nausea and vomiting (PONV; RR=0.49, p<0.00001, I2=0). Postoperative bradycardia, hypotension, and urinary retention were not significantly different between clonidine and other adjuncts (p>0.05).ConclusionClonidine, compared with other adjuncts, added to local anesthetics for neuraxial block, provides a longer duration of postoperative analgesia with lower incidence of PONV. However, the duration of motor block may also be prolonged by clonidine.

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“…As pain was assessed by different scoring systems, we were not able to calculate an average pain score for the included studies. However, a recent published Cochrane review 13 assumed the definition of various postoperative pain thresholds to be equivalent and therefore adequate to assess the duration of rescue analgesia. Most of the pain scales were based on a 10-or 12-point scale with 3 or 4 as pain trigger.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and adverse effects of ketamine as an additive for paediatric caudal anaesthesia: a quantitative systematic review of randomized controlled trials

Schnabel

Poepping

Kranke

et al. 2011

British Journal of Anaesthesia

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Diclofenac for acute pain in children

Cited by 20 publications

References 119 publications

Diclofenac pharmacokinetic meta‐analysis and dose recommendations for surgical pain in children aged 1–12 years

Diclofenac pharmacokinetic meta‐analysis and dose recommendations for surgical pain in children aged 1–12 years

Clonidine versus other adjuncts added to local anesthetics for pediatric neuraxial blocks: a systematic review and meta-analysis

Efficacy and adverse effects of ketamine as an additive for paediatric caudal anaesthesia: a quantitative systematic review of randomized controlled trials

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