Prophylactically-Administered Rectal Acetaminophen Does Not Reduce Postoperative Opioid Requirements in Infants and Small Children Undergoing Elective Cleft Palate Repair

Bremerich, Dorothee H.; Neidhart, Gerd; Heimann, Klaus; Kessler, Paul; Behne, M.

doi:10.1097/00000539-200104000-00020

Cited by 83 publications

(62 citation statements)

References 21 publications

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“…Yet, there is a paucity of research relating to the benefits of orally and rectally administered acetaminophen in neonates and infants. Findings from the few studies including newborn or young infants have generally shown little analgesic benefits [41][42][43][44]. Well-conducted studies of enterally administered acetaminophen, given alone or in combination with other analgesics, are required to address this knowledge gap.…”

Section: Acetaminophenmentioning

confidence: 99%

Strategies for the Prevention and Management of Neonatal and Infant Pain

Harrison

Yamada

Stevens

2010

Curr Pain Headache Rep

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Health care professionals caring for neonates (birth to 28 days of life) and infants up to 1 year of age have a professional and ethical responsibility to provide safe and effective pain management during painful procedures. Despite 14 years of research reports highlighting that sick infants are exposed to large numbers of painful procedures with minimal or no provision of pain management strategies, and generation of abundant evidence to support effectiveness of pain reduction strategies, insufficient practice changes have been made. As untreated pain in infancy has both immediate and longer-term negative consequences, such as increased sensitivity and responses to subsequent pain, it is imperative that widespread sustained practice changes are made to reduce the burden of pain. This review highlights recent advances within the past 2 to 3 years in pain management of acute procedural pain for neonates and infants, proposes recommendations for future research, and addresses practical implications and challenges for implementing best pain management practices.

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Section: Acetaminophenmentioning

confidence: 99%

Strategies for the Prevention and Management of Neonatal and Infant Pain

Harrison

Yamada

Stevens

2010

Curr Pain Headache Rep

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“…. ,46± 49,52±54] that examined pre-emptive analgesia, as de®ned above (Table 3) [15] 2001 DB, DA [16] 2001 MP [17] 2002 A NSAIDs [18] 2001 DA [19] 2002 P [20] 2002 DB Opioids [21] 2001 DA NMDA antagonists [22] 2001 P [23] 2001 MP [24] 2001 P [25] 2001 P Tricyclic antidepressants [26] 2001 DA, MP Local anesthetics and opioids [27] 2001 DB [28] 2002 DB [29] 2001 DA Local anesthetics and NSAIDs [30] 2001 DB…”

Section: Pre-emptive Analgesiamentioning

confidence: 99%

Current status of pre-emptive analgesia

Katz

McCartney

2002

Current Opinion in Anaesthesiology

110

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Purpose of reviewThe controversy over pre-emptive analgesia continues unabated, with studies both supporting and refuting its efficacy. The timing of an analgesic intervention and presence of a placebo control may have significant impact on the interpretation of results and may have led to the premature conclusion that pre-emptive analgesia is of limited clinical utility. A review of the recent literature using strict definitions of preemptive and preventive analgesia is required in order to clarify the broader issue of the benefits of perioperative analgesia. Recent findings A total of 27 studies, published from April 2001 to April 2002, were found to evaluate pre-emptive (n = 12) or preventive analgesia (n = 15). Evidence for a benefit of preventive analgesia was strong, with 60% of studies finding reduced pain or analgesic consumption beyond the clinical duration of action of the analgesic intervention. Evidence for a benefit of preemptive analgesia was equivocal, with 41.7% of studies demonstrating that preincisional treatment reduces pain or analgesic consumption to a greater extent than does postincisional treatment. Summary Studies that used a preventive design had a greater likelihood of finding a beneficial effect. The application of preventive perioperative analgesia (not necessarily preincisional) is associated with a significant reduction in pain beyond the clinical duration of action of the analgesic agent, in particular for the N-methyi-D-aspartate antagonists. The classical definition of pre-emptive analgesia should be abandoned in favor of preventive analgesia. This will broaden the scope of inquiry from a narrow focus on preincisional versus postincisional interventions to one that aims to minimize postoperative pain and analgesic requirements by reducing peripheral and central sensitization arising from noxious preoperative, intraoperative and postoperative inputs.

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“…Lediglich zwei Untersuchungen beziehen sich offensichtlich auf in Deutschland verbreitete Präparate wie z. B. ben-u-ron ® [26,87].…”

Section: Orale Gabeunclassified

“…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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Prophylactically-Administered Rectal Acetaminophen Does Not Reduce Postoperative Opioid Requirements in Infants and Small Children Undergoing Elective Cleft Palate Repair

Cited by 83 publications

References 21 publications

Strategies for the Prevention and Management of Neonatal and Infant Pain

Strategies for the Prevention and Management of Neonatal and Infant Pain

Current status of pre-emptive analgesia

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

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