Diclofenac or Paracetamol for Analgesia in Paediatric Myringotomy Outpatients

Tay, Chin Lin; Tan, Shaohua

doi:10.1177/0310057x0203000110

Cited by 19 publications

(7 citation statements)

References 10 publications

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“…Paracetamol alone was given as an analgesic after adenoidectomy ± myringotomy at many units. Oral diclofenac and paracetamol are documented to be equipotent after myringotomy (37), but many authors recommend combined therapy with paracetamol and NSAID after adenoidectomy and tonsillectomy (36, 38, 39). Strong opioids are not routine analgesics in paediatric ambulatory care.…”

Section: Discussionmentioning

confidence: 99%

Children in day surgery: clinical practice and routines. The results from a nation‐wide survey

Segerdahl

Warrén-Stomberg

Rawal

et al. 2008

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

Children in day surgery: clinical practice and routines. The results from a nation‐wide survey

Segerdahl

Warrén-Stomberg

Rawal

et al. 2008

Acta Anaesthesiol Scand

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“…The non-steroidal anti-inflammatory drug (NSAID) diclofenac is widely used to manage acute pain in children [1], but there is no licensed paediatric oral formulation in the UK, and dosing is yet to be properly established. Published clinical studies use single doses ranging from 0.5 [2] to 2.5 mg kg -1 [3]. Clinical experience suggests that doses over 1 mg kg -1 may be more effective in children but the optimum dose is still a matter for debate [4].…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics of oral diclofenac for acute pain in children

Standing

Howard

Johnson

et al. 2008

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Diclofenac is an effective oral analgesic for acute postoperative pain. In adults 25 mg is half as effective as 50 mg, but 50 mg and 100 mg are similarly effective (ceiling effect). Diclofenac has linear pharmacokinetics in this range.• Diclofenac is frequently used 'off-label' in children for acute pain but optimum dosing is unclear (dosing of diclofenac in clinical paediatric studies ranges from 0.5-2.5 mg kg -1 ). There is currently no licensed oral paediatric formulation of diclofenac. WHAT THIS STUDY ADDS• Using a new diclofenac oral suspension, a dose of 1 mg kg -1 in children aged 1 to 12 years gives a similar exposure to 50 mg in adults; paediatric patients are unlikely to benefit from higher doses. AIMSTo develop a population pharmacokinetic model for a new diclofenac suspension (50 mg 5 ml -1 ) in adult volunteers and paediatric patients, and recommend a dose for acute pain in children. METHODSBlood samples were drawn at the start and end of surgery, and on removal of the venous cannula from 70 children (aged 1 to 12 years, weight 9 to 37 kg) who received a preoperative oral 1 mg kg -1 dose; these were pooled with rich (14 post-dose samples) data from 30 adult volunteers. Population pharmacokinetic modelling was undertaken with NONMEM. The optimum adult dose of diclofenac for acute pain is 50 mg. Simulation from the final model was performed to predict a paediatric dose to achieve a similar AUC to 50 mg in adults. RESULTSA total of 558 serum diclofenac concentrations from 100 subjects was used in the pooled analysis. A single disposition compartment model with first order elimination and dual absorption compartments was used. The estimates of CL/F and VD/F were 53.98 l h -1 70 kg -1 and 4.84 l 70 kg -1 respectively. Allometric size models appeared to predict adequately changes in CL and VD with age. Of the simulated doses investigated, 1 mg kg -1 gave paediatric AUC(0,12 h) to adult 50 mg AUC(0,12 h) ratios of 1.00, 1.08 and 1.18 for ages 1-3, 4-6 and 7-12 years respectively. CONCLUSIONSThis study has shown 1 mg kg -1 diclofenac to produce similar exposure in children aged 1 to 12 years as 50 mg in adults, and is acceptable for clinical practice; patients are unlikely to obtain further benefit from higher doses.

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“…Paracetamol produces dose-related analgesia; 10 mgAEkg )1 orally is no better than placebo (3) or is associated with higher supplemental requirements (8), whereas pain scores are low with 15-20 mgAEkg )1 (1,2,4,5,9).…”

Section: Evidencementioning

confidence: 99%

“…Oral paracetamol, ibuprofen, or diclofenac, in suitable doses, administered 30 min preoperatively can achieve adequate early postoperative analgesia: Grade B ( 1,2 ).…”

Section: 2 Ent Surgerymentioning

confidence: 99%

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Postoperative pain

Howard¹,

Carter²,

Curry³

et al. 2008

Pediatric Anesthesia

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Concentrations associated with arousal in children are analogous to adults. The ability to recall and remember occurs at similar concentrations to those associated with arousal. A concentration of 1 mg.l(-1) was associated with a sedation level of three or less (arouses to consciousness with moderate tactile or loud verbal stimulus) in 95% of children while 1.5 mg.l(-1) was associated with a sedation level of two or less (rouses slowly to consciousness with sustained painful stimulus) in 95% of children. These concentrations can be attained for 3-4 min after 1 mg.kg(-1) and 1.5 mg.kg(-1) ketamine IV bolus, respectively. The mean arousal time can be anticipated at approximately 10 min (1 mg.kg(-1)) and 15 min (1.5 mg.kg(-1)).

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Diclofenac or Paracetamol for Analgesia in Paediatric Myringotomy Outpatients

Cited by 19 publications

References 10 publications

Children in day surgery: clinical practice and routines. The results from a nation‐wide survey

Children in day surgery: clinical practice and routines. The results from a nation‐wide survey

Population pharmacokinetics of oral diclofenac for acute pain in children

Postoperative pain

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