Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery

Abstract

Background:Analgesic efficacy of rectal acetaminophen is variable in different surgical procedures. Little data is available on its efficacy in ophthalmic surgeries. We conducted this prospective, randomized, double blind study to evaluate and compare the efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery over a 24 hour period.Materials and Methods:135 children scheduled for elective ophthalmic surgery were randomly allocated to one of the three groups, high, low, or control (H, L, or N) and received rectal acetaminophen 40 mg/kg, 20 mg/kg or no rectal drug respectively after induction of general anesthesia. Postoperative observations included recovery score, hourly observational pain score (OPS) up to 8 hours, time to first analgesic demand, and requirement of rescue analgesics and antiemetics over a 24 hour period.Results:Nineteen of 30 (63%) of children in group N required postoperative rescue analgesic versus 5/48 (10%) of group H (P <0.0001) and 10/47 (23%) of group L (P =0.0005) during 24 hour period. Mean time to requirement of first analgesic was 206±185 min in group H, 189±203min in group L, and 196 ±170 min in group N (P=0.985). OPS was significantly lower in group H and L compared to group N during first 8 hours. Requirement of rescue antiemetic was 18.7% in group H as compared to 23% each in group L and group N (P >0.5).Conclusions:Single dose rectal acetaminophen can provide effective postoperative analgesia for pediatric ophthalmic surgery at both high dose (40 mg/kg) and low dose (20 mg/kg) both in early postoperative and over a 24 hour period.

Ultrasound-guided ilioinguinal/iliohypogastric block did not reduce emergence delirium after ambulatory pediatric inguinal hernia repair: a prospective randomized double-blind study

“…This low dose of acetaminophen and lack of NSAIDs may have provided inadequate analgesia for inguinal repair, resulting in a high PAED scale and BOPS scores. However, as several previous studies have documented using low-dose acetaminophen as a clinically therapeutic dose to treat postoperative pain [24,25], we chose a low dose of acetaminophen in our study. Furthermore, considering that no patient required postoperative rectal acetaminophen and that the BOPS scores were very low by the time of discharge from hospital, we do not think that low-dose rectal acetaminophen and the lack of NSAIDs were a problem clinically.…”

Anesthetic complications during general anesthesia without intravenous access in pediatric ophthalmologic clinic: assessment of 5216 cases

“…In a study by Gandhi et al, a single dose of acetaminophen applied rectally proved to be an effective method of pain control following pediatric ophthalmic surgeries. 15 IV placement itself can be a source of pain. In a survey of infants and parents following myringotomies, the group without IV exhibited greater satisfaction and lower pain scores than those with IV placement.…”

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“…In liver surgery, excessive bleeding, massive infusion and blood transfusion have a great effect on postoperative recovery (Gandhi and Sunder, 2012). Total hepatic vascular exclusion has been a common approach in liver resection to minimize blood loss, whereas the risk of hepatic ischemia/reperfusion injury (HIRI) has increased (Kelly et al, 2011).…”