Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial

El-Fattah, Ahmed Musaad Abd; Ramzy, Eiad A.

doi:10.1017/s0022215113000364

Cited by 12 publications

(16 citation statements)

References 32 publications

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“…Basic level • Intravenous fentanyl in divided doses • Rectal NSAID or if not available rectal paracetamol after induction of anesthesia or oral paracetamol or NSAID as a part of premedication (preemptive analgesia). 164 • Local wound infiltration by the surgeon of a long-acting local anesthetic. 60,139,[165][166][167][168][169] • Intravenous fentanyl or morphine or other suitable agent (if available) to treat breakthrough pain in the PACU 51,[170][171][172] • Oral NSAIDs and/or paracetamol in adequate dosage during the entire postoperative period from the moment when the oral intake will be possible.…”

Section: Intraoperative Postoperativementioning

confidence: 99%

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Vittinghoff

Lönnqvist

Mossetti

et al. 2018

Pediatric Anesthesia

123

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The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.

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Section: Intraoperative Postoperativementioning

confidence: 99%

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Vittinghoff

Lönnqvist

Mossetti

et al. 2018

Pediatric Anesthesia

123

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“…El-fattah et al also demonstrated in post-tonsillectomy paediatric patient that postoperative pain measure scores of control group children were significantly higher within the first 3 post-operative days (p = 0.000), with a greater percentage of children experiencing significant pain and requiring more analgesia then study group who received pre-emptive analgesia. [30] Acute pain results in sympathetic over activity which is manifested by increase in heart rate, blood pressure, peripheral resistance and cardiac output. [31] In this present study, heart rate and blood pressure remained stable throughout the study period in Gr.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries

Iqbal¹,

Mujoo²,

Saleem³

et al. 2016

AIMDR

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Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using "Modified Steward Coma Scale"at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group-P40 was (646±9.94) min Group-D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.

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“…Die Autoren errechneten eine gute Korrelation zwischen den Messinstrumenten und beurteilten sie als gleichwertige Skalen [45]. El-Fattah et al verwendeten den PPPM, um ein präemptives Tripel-Analgesie-Protokoll bei Kindern zwischen 5 und 12 Jahren nach TE zu untersuchen [46]. Wir verwendeten in dieser Studie erstmals die deutsche Version dieser Beobachtungs-Skala zur Einschätzung von Schmerzen nach Tonsillektomien.…”

Section: Diskussionunclassified

Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen

et al. 2018

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Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial

Abstract: The proposed multimodal, pre-emptive analgesia protocol for paediatric post-tonsillectomy pain results in less post-operative pain, both in hospital or at home.

Cited by 12 publications

References 32 publications

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries

Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen

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