To compare rectal and oral acetaminophen for postoperative pain relief in children undergoing craniofacial surgery
Author(s): Dr. N. Murali Krishna and Sreedhar Ganga
Abstract:Background and objectives: In newborns and infants who have just undergone major surgery, the plasma concentrations of the painkiller acetaminophen (INN, paracetamol) have not yet been determined in the research literature. As a result, we conducted a study in the intensive care unit of our hospital.
Study Methods: During elective craniofacial correction, 40 toddlers with a mean (standard deviation) age of 10.3 (2.3) months received 20 mg/kg of acetaminophen orally (n = 20) or rectally (n = 20) every 6 hours following a rectal loading dose of 40 mg/kg. Pain assessments were made every three hours, and blood samples were taken an hour before and two hours after the administration of acetaminophen maintenance dosages.
Results and discussion: The mean area under the concentration-time curve (AUC) for patients receiving rectal acetaminophen was 171.2 mg/h/L, while the mean AUC for patients receiving oral acetaminophen was 111.9 mg/h/L. Patients receiving oral acetaminophen reported greater pain scores. However, acetaminophen plasma concentrations and pain scores did not differ across the groups once the patients who vomited were removed from the oral acetaminophen group. Acetaminophen plasma concentrations and pain ratings did not correlate. Despite the fact that 9 out of 40 patients (or 22.5%) did not achieve the desired analgesic acetaminophen plasma concentrations of 10 to 20 mg/L, 7.5% of the pain scores on the visual analogue scale were higher than the 4 cm cutoff criterion.
Conclusion: These are the first results demonstrating that following major surgery in this age range, the analgesic acetaminophen plasma concentration does not always reach the 10 to 20 mg/L level. These results also demonstrate that the rectal route is the most effective approach to provide acetaminophen following craniofacial surgery once a rectal loading dosage of 40 mg/kg has been administered during surgery.
Dr. N. Murali Krishna, Sreedhar Ganga. To compare rectal and oral acetaminophen for postoperative pain relief in children undergoing craniofacial surgery. Int J Adv Res Med 2021;3(2):626-630. DOI: 10.22271/27069567.2021.v3.i2i.404