On-Demand Analgesia with Piritramidein Children - A Study on Dosage Specification and Safety

Petrat, G; Klein, U.; Meissner, Wiktor

doi:10.1055/s-2008-1071046

Cited by 18 publications

(10 citation statements)

References 2 publications

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“…Fentanyl undergoes hepatic metabolism to inactive metabolites and is useful in renal failure. [34] A low incidence of nausea and vomiting and an absence of pruritus were also noted in this sample of 20 children receiving postoperative PCA. palliative care, repeated procedures duration of action than morphine.…”

Section: Selection Of a Suitable Opioidsupporting

confidence: 57%

Patient-Controlled Analgesia

McDonald

Cooper

2001

Paediatric Drugs

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Patient-controlled analgesia (PCA) is an analgesic technique originally used in adults but now with an established role in paediatric practice. It is well tolerated in children as young as 5 years and has uses in postoperative pain as well as burns, oncology and palliative care. The use of background infusions is more frequent in children and improves efficacy; however, it may increase the occurrence of adverse effects such as nausea and respiratory depression. Monitoring involves measurement of respiratory rate, level of sedation and oxygen saturation. Efficacy is assessed by self-reporting, visual analogue scales, faces pain scales and usage patterns. This is optimally performed both at rest and on movement. The selection of opioid used in PCA is perhaps less critical than the appropriate selection of parameters such as bolus dose, lockout and background infusion rate. Moreover, opioid choice may be based on adverse effect profile rather than efficacy. The concept of PCA continues to be developed in children, with patient-controlled epidural analgesia, subcutaneous PCA and intranasal PCA being recent extensions of the method. There may also be a role for patient-controlled sedation. PCA, when used with adequate monitoring, is a well tolerated technique with high patient and staff acceptance. It can now be regarded as a standard for the delivery of postoperative analgesia in children aged >5 years.

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Section: Selection Of a Suitable Opioidsupporting

confidence: 57%

Patient-Controlled Analgesia

McDonald

Cooper

2001

Paediatric Drugs

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“…Petrat et al [15] performed a study with a patient-controlled analgesia (PCA) with piritramide in 2.7-12.6-year-old children after major surgery. Doses of 20-50 μg/kg body weight (bw) and a 4-h maximum dose of 0.1-0.2 mg/kg bw did not produce adequate analgesia.…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of the pharmacodynamics of piritramide in neonates and infants

et al. 2007

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Piritramide is a synthetic opioid commonly used in Germany and Austria for the analgesia of pediatric patients. Little pharmacokinetic and pharmacodynamic data for the pediatric population is available. The aim of this investigation was to gain pharmacodynamic data on postsurgical analgesia and the side effects of piritramide. The study was approved by the Ethics Committee of the Medical Faculty. Data were collected in an open, prospective clinical trial. After obtaining the parents' informed written consent, patients received a bolus of piritramide 50 mug/kg for postsurgical analgesia or to prevent pain resulting from invasive procedures. Titration doses of 15 microg/kg were allowed. Vital signs and pain intensity were closely monitored. Data from 39 patients could be included in the analysis. Of the patients, 95% were in the immediate postsurgical course, 5% had piritramide for invasive procedures, and 46% of the patients were ventilated. The mean piritramide dosage was 64 +/- 24 microg/kg. Pharmacodynamic analysis showed adequate analgesia for at least 50% of the spontaneously breathing patients for 120 min after piritramide bolus. More than 50% of the ventilated patients showed inadequate analgesia at any point in time after piritramide bolus. Fifty-nine percent (59%) of the ventilated patients received additive analgesia versus 31% of spontaneously breathing patients. No relevant changes of vital signs could be observed. One patient received naloxone for apnea. We conclude that dosages of more than 50-70 microg/kg are needed for sufficient analgesia in ventilated postsurgical infants. In spontaneously breathing patients, 50-70 microg/kg provides a 120-min period of analgesia for more than 50% of patients. Cardiovascular stability of the patients was good and, with one exception, there was no respiratory depression.

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“…verabreicht werden kann. Am häufigsten wird Piritramid postoperativ eingesetzt, da eine 7 verminderte Darmatonie und ein reduziertes Auftreten von Erbrechen vermutet werden [37]. Postoperativ ist bei einem relevanten Eiweiß-und Blutverlust oder einer Azidose eine Dosisreduktion oder Titration zu beachten [44].…”

Section: Nichtsteroidale Antiphlogistika (Nsaid)unclassified

Therapie akuter Schmerzen bei Kindern und Jugendlichen

Heinrich

Hoffmann

Zernikow

2010

Monatsschr Kinderheilkd

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Schmerzen gehören zu den häufigsten Ursachen für eine Konsultation des Kinderarztes. Die Stär-ke akuter Schmerzen kann anhand von Selbstbewertungs-oder Beobachtungsskalen erhoben werden. Akute Schmerzen jeder Genese müssen schnellstmöglich behandelt werden. Nach Ursachenerforschung und kausal ausgerichteter Therapie sind Ibuprofen und Paracetamol die am häufigsten eingesetzten Analgetika. Bei Letzterem sind das niedrige analgetische Potenzial sowie die geringe therapeutische Breite zu beachten. Bei starken bis sehr starken akuten Schmerzen sollten auch bei Kindern Opioide Mittel der ersten Wahl sein. Im Rahmen der postoperativen Schmerzbehandlung kommen Analgetikaregimes mit Basis-und Bedarfsanalgesie zum Einsatz. Starke Schmerzerfahrungen im Kindesalter können zur psychischen Traumatisierung führen und über die Ausbildung eines Schmerzgedächtnisses langfristig das Schmerzempfinden beeinflussen. Schmerzen müssen deshalb konsequent zu vermeiden versucht bzw. behandelt werden. AbstractPain is one of the most common causes for consultation of a paediatrician and represents a major problem in paediatrics. Simple self-reporting and behavioural pain scales are suitable for assessment of intensity of acute pain. Acute pain of whatever origin should be treated immediately. The most commonly used analgesics are ibuprofen and paracetamol (acetaminophen). In the case of paracetamol the narrow therapeutic range should be kept in mind. Opioids should be first choice in therapy of severe pain, also for children. Perioperative pain should be treated with a combination of non-pharmacological and pharmacological strategies with basis medication and medication on demand. Experience of severe pain can result in the generation of a chronic pain memory with emotional trauma which can have a long-term influence on the sensitivity to pain. Therefore, every effort should be made to prevent pain and to treat it effectively.

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On-Demand Analgesia with Piritramidein Children - A Study on Dosage Specification and Safety

Cited by 18 publications

References 2 publications

Patient-Controlled Analgesia

Patient-Controlled Analgesia

Prospective evaluation of the pharmacodynamics of piritramide in neonates and infants

Therapie akuter Schmerzen bei Kindern und Jugendlichen

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