Postoperative Analgesia in Children Undergoing Myringotomy and Placement Equalization Tubes in Ambulatory Surgery

Pappas, Ana Lucia; Fluder, Elaine; Creech, Steven; Hotaling, Andrew J.; Park, Albert

doi:10.1213/01.ane.0000064206.51296.1d

Cited by 46 publications

(33 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Paracetamol also has little antiplatelet activity and does not affect bleeding time, unlike NSAIDs [7]. Although enteral formulations of paracetamol are the most commonly used analgesics for management of pain in children, their analgesic efficacy is weak after ENT surgery [8,9]. An intravenous (IV) formulation of paracetamol recently has become available, and it achieves target plasma concentration more rapidly with reduced variability compared with the rectal and oral formulations [10,11].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children

Uysal

Takmaz

Yaman

et al. 2011

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children

Uysal

Takmaz

Yaman

et al. 2011

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

“…A small number of randomized, controlled trials in children have also shown effective analgesia, with a reduction in morphine requirements leading to reduced postoperative vomiting compared with an opioid-based analgesic. 110 However, bleeding time may be increased, 111 and some reports 112 show an increase in postoperative clinical bleeding, although there are no randomized, controlled trials that have included neonates. A case series of infants younger than 6 months after abdominal surgery suggested a reduction in morphine requirements when ketorolac was used.…”

Section: Reducing Pain From Surgerymentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

419

View full text Add to dashboard Cite

The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

show abstract

“…One commonly used option, the administration of rectal acetaminophen, has been shown to provide insufficient analgesia when used alone [1–3]. In many centers, IN fentanyl remains a commonly used analgesic although there are questions regarding its efficacy and investigations continue in the hopes of finding a better alternative.…”

Section: Discussionmentioning

confidence: 99%

“…However, the tympanic membrane is quite sensitive and given that intravenous access is not available, an alternative route of drug delivery for postoperative analgesia is needed. In many cases, acetaminophen is administered per rectum; however, this alone is generally not sufficient to provide effective analgesia [1–3]. Other suggested regimens for the provision of postoperative analgesia have included oral acetaminophen–codeine, intramuscular (IM) ketorolac and intranasal (IN) butorphanol; although perhaps the most commonly employed analgesic method is IN fentanyl [4–7].…”

Section: Introductionmentioning

confidence: 99%

Pain management following myringotomy and tube placement: Intranasal dexmedetomidine versus intranasal fentanyl

Dewhirst

Fedel

Raman

et al. 2014

International Journal of Pediatric Otorhinolaryngology

View full text Add to dashboard Cite

Purpose Despite the brevity of the procedure, bilateral myringotomy and tympanostomy tube placement (BMT) can result in significant postoperative pain and discomfort. As the procedure is frequently performed without intravenous access, non-parenteral routes of administration are frequently used for analgesia. The current study prospectively compares the efficacy of intranasal (IN) dexmedetomidine with IN fentanyl for children undergoing BMT. Methods This prospective, double-blinded, randomized clinical trial included pediatric patients undergoing BMT. The patients were randomized to receive either IN dexmedetomidine (1 μg/kg) or fentanyl (2 μg/kg) after the induction of general anesthesia with sevoflurane. All patients received rectal acetaminophen (40 mg/kg) and the first 50 patients also received premedication with oral midazolam. Postoperative pain and recovery were assessed using pediatric pain and recovery scales, and any adverse effects were monitored for. Results The study cohort included 100 patients who ranged in age from 1 to 7.7 years and in weight from 8.6 to 37.4 kg. They were divided into 4 groups with 25 patients in each group: (1) midazolam premedication + IN dexmedetomidine; (2) midazolam premedication + IN fentanyl; (3) no premedication + IN dexmedetomidine; and (4) no premedication + IN fentanyl. Pain scores were comparable when comparing groups 2, 3 and 4, but were higher in group 1 (midazolam premedication with IN dexmedetomidine). There was no difference in total time in the post-anesthesia care unit (PACU) or time from arrival in the PACU until hospital discharge between the 4 groups. The heart rate (HR) was significantly lower in group 3 when compared to the other groups at several different times after arrival to the PACU. No clinically significant difference was noted in blood pressure. Conclusion Following BMT, when no premedication is administered, there was no clinical advantage when comparing IN dexmedetomidine (1 μg/kg) to IN fentanyl (2 μg/kg). The addition of oral midazolam as a premedication worsened the outcome measures particularly for children receiving IN dexmedetomidine.

show abstract

Postoperative Analgesia in Children Undergoing Myringotomy and Placement Equalization Tubes in Ambulatory Surgery

Cited by 46 publications

References 8 publications

The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children

The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children

Prevention and Management of Pain in the Neonate: An Update

Pain management following myringotomy and tube placement: Intranasal dexmedetomidine versus intranasal fentanyl

Contact Info

Product

Resources

About