Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy

Watcha, Mehernoor F.; Ramirez-Ruiz, M.; White, Paul F.; Jones, M. Barry; Lagueruela, Richard G.; Terkonda, R.P.

doi:10.1007/bf03008224

Cited by 186 publications

(140 citation statements)

References 22 publications

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“…Emergence agitation (EA) was also evaluated at arrival and 30 min of PACU using a modified four-point scale by Watcha et al 16) (1=calm, 2=crying, but can be consoled, 3=crying and cannot be consoled, 4=agi-tated and thrashing around). Children with a score of 3/4 were considered to be having an EA episode.…”

Section: Methodsmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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When local anesthetics are used, the administration of dexmedetomidine (DEX) can prolong analgesic duration. However, the effect of caudal DEX on high volume/low concentration (HVLC) local anesthetics has not been studied. We investigated the analgesic effect of DEX added to a HVLC of ropivacaine for caudal block in children. Eighty children (the American Society of Anesthesiologists (ASA) status I; age, 1-6 years) undergoing ambulatory orchiopexy were enrolled in the study. Children were randomly assigned to undergo a caudal block with 1.5 mL/kg of 0.15% ropivacaine and either 1 µg/kg of DEX (DEX group, n 40) or the same amount of saline (Control group, n 40) under general anesthesia. The results showed that the time to first analgesic request was significantly longer in the DEX group than in the control group. The sevoflurane requirement for anesthesia and frequency of emergence agitation (EA) were also significantly lower in the DEX group. There was no difference in adverse events between the two groups. In conclusion, a dose of 1 µg/ kg of caudal DEX prolonged the first analgesic request time, although the immediate postoperative pain scores were comparable in both groups. Furthermore, caudal DEX significantly reduced the sevoflurane requirement and the frequency of EA.Key words dexmedetomidine; caudal block; child; orchiopexy Caudal block is common method for postoperative analgesia in children undergoing infra-umbilical surgery. One major limitation of caudal block is a relatively short analgesic duration owing to the single-injection. Thus, adjuvants such as ketamine, clonidine, or opioids are frequently added to the local anesthetics in order to improve analgesic efficacy and duration.1,2) The effectiveness of local anesthetics using in caudal block is dependent upon the dose, volume, and concentration of the local anesthetic solution, but high-concentration local anesthetics can increase the incidence of motor weakness, delayed micturition, or urinary retention. In children undergoing ambulatory surgery, such adverse effects can prolong the discharge time and may result in inadvertent admission. Recently, high-volume/low-concentration (HVLC) regimens for caudal blocks in children (1.5 mL/kg of 0.1-0.2% local anesthetics) have gained popularity following a report by Silvani et al. that demonstrated that a HVLC regimen provides a longer analgesic duration with less adverse effects than conventional dose/concentration. [3][4][5][6][7][8] However, the analgesic duration is still limited in caudal block with single-injection.Dexmedetomidine (DEX) is a highly selective α 2 adrenoceptor agonist with an α2/α1 selectivity ratio of 1600 : 1, and is eight times more potent than clonidine. 9) DEX is successfully used as an adjuvant in caudal blocks for children in order to reduce pain without inducing any significant respiratory and hemodynamic effects. Several studies have reported that in children, caudal DEX (1-2 µg/kg) with 0.25% bupivacaine (1 mL/kg) prolongs postoperative analgesic duration by 2.5-3 fold comp...

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Section: Methodsmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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“…18 A score of 0 was assigned if the child was asleep. A single clinical research nurse, unaware of the patient's treatment, conducted and recorded pain assessments every five minutes for the first fifteen minutes and every fifteen minutes thereafter.…”

Section: Clinical Evaluationsmentioning

confidence: 99%

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

Pestieau

Quezado

Johnson

et al. 2011

Can J Anesth/J Can Anesth

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“…So konnte in 2 placebokontrollierten Studien mit 15-20 mg/kg KG Paracetamol keine suffiziente postoperative Analgesie nach Parazentese erzielt werden [18,88]. Bei Neugeborenen nach Zirkumzision zeigte sich mit der gleichen Dosierung erst 6 h nach Applikation eine signifikante Reduktion der Schmerzintensität [43].…”

Section: Analgetische Wirksamkeit Von Paracetamol In Niedriger Dosierungunclassified

“…Klar erscheint lediglich, dass Paracetamol als Monoanalgetikum in einer Dosis von bis zu 20 mg/kg KG bei Kindern zur postoperativen Schmerztherapie, unabhängig vom operativen Eingriff, nicht ausreicht [18,63,66,77,78,85,88]. Demgegenüber zeigt sich, bis auf eine Ausnahme [26], bei Initialdosen von >35 mg/kg KG ein durchweg guter analgetischer Effekt [8,24,49,56,82].…”

Section: Kritische Wertung Der Literatur Unter Klinischen Aspekten Zuunclassified

Paracetamol im Kindesalter Aktueller Wissensstand und Hinweise für einen rationalen Einsatz zur postoperativen Analgesie

Mantzke¹,

Brambrink²

2002

Anaesthesist

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The administration of paracetamol (in the US known as acetaminophen) to children and infants for postoperative pain after minor surgery is a well established and safe treatment option, if appropriately used. However, if paracetamol is dosed according to traditional recommendations (about 20 mg/kg body weight) frequently a sufficient analgetic effect cannot be achieved immediately after painful interventions. Recently, a higher initial dose (40 mg/kg body weight) was suggested for effective postoperative pain control, which seems especially important for children after ambulatory anesthesia, but may also be associated with certain risks to the patient. Current recommendations also involve appropriate timing and route of administration of paracetamol to be most effective under different clinical circumstances. In contrast, the risk for liver toxicity appears to be very low, if the daily paracetamol dose does not exceed 90 mg/kg body weight in otherwise healthy children, and if specific risk factors of the individual patient are always considered. This review discusses the recent publications on pharmacokinetics and -dynamics, the clinical use and dosing, as well as the risks and benefits of paracetamol for the treatment of postoperative pain in children and infants. Based on this information, specific dosing regimes for the postoperative period are suggested for neonates and infants, as well as for children in different age groups.

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Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy

Cited by 186 publications

References 22 publications

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

Paracetamol im Kindesalter Aktueller Wissensstand und Hinweise für einen rationalen Einsatz zur postoperativen Analgesie

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