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Cited by 230Anesthesia and Pain ManagementPediatric Pain Management TechniquesPain Management and Opioid Use

The DOI matches its Crossref record; 31 of the 31 references it cites were found in a registry or an index.

Morphine-sparing Effect of Acetaminophen in Pediatric Day-case Surgery

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Korpela, Reijo, Korvenoja, Pekka, Meretoja, Olli A.·1999·Anesthesiology
DOI 10.1097/00000542-199908000-00019
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Abstract

Background: Postoperative pain is a major problem in day-case surgery in children. Nonsteroidal antiinflammatory drugs have gained popularity in management of pediatric surgical patients to reduce the need for opioids. The aim of this study was to evaluate the efficacy of different doses of rectal acetaminophen in day-case surgery in children. Methods: A randomized, double-blinded, placebo-controlled study design was used. Patients (n = 120) were randomized to receive a single dose of 0, 20, 40, or 60 mg/kg of rectal acetaminophen after induction of anesthesia. General anesthesia was induced by mask ventilation with sevoflurane (7%) in nitrous oxide and oxygen and maintained with 2.5-4.0% end-tidal sevoflurane. Opioids or local anesthetics were not used. Postoperative pain was evaluated by behavioral assessment and physiologic measurements every 10 min after arrival at the postanesthesia care unit. The pain intensity was scored using a 0-100 visual analog scale used in the authors' clinic. The need for rescue medication, intravenous morphine 0.1 mg/kg, was decided by the nurse, who was unaware of the rectal acetaminophen dose. The parents were interviewed by phone after 24 h regarding pain and its treatment, nausea, and vomiting. Rescue analgesia at home was rectal ibuprofen, 10 mg/kg. Results: In the postanesthesia care unit pain scores were significantly lower in the 40- and 60-mg/kg groups compared with placebo and 20-mg/kg groups. Acetaminophen resulted in a dose-related reduction in the number of children who required postoperative rescue opioid, with significance reached with 40 or 60 mg/kg doses. Calculated dose of acetaminophen at which 50% of the children not requiring a rescue opioid was 35 mg/kg. The need for rescue analgesia at home during the first 24 h after surgery was also significantly less in patients in the 40- or 60-mg/kg groups than in the 0- or 20-mg/kg groups (20-17 vs. 80-63%). Thirty-three percent of patients receiving placebo had postoperative nausea and vomiting, compared with 0-3% in groups receiving 40 or 60 mg/kg acetaminophen. Conclusions: A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children if administered at the induction of anesthesia. Moreover, children with adequate analgesia with acetaminophen have less postoperative nausea and vomiting.

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  1. [16]16. Birmingham PK, Tobin MJ, Henthorn TK, Fisher DM, Ikrkel- hatner MC, Smith FA, Fanta KB, Cote CJ: Twenty-four-hour pharmaco- kinetics of rectal acetaminophen in children. ANESTHESIOLOGY 1997; 87:244 -52
  2. [19]19. Montgomery CJ, McCormack JP, Reichert CC, Marsland CP: Plas1n;i concentrations after high-dose (45 mg kg-I) rectal acetamino- phen in children. Can J Anaesth 1995; 42:982-6
  3. [22]22. Windorfer A, Vogel C : Investigations concerning serum concen- tration and temperature following oral application of a new paraceta- mol preparation. Klin Paediatr 1976; 188:4jO-4
  4. [30]30. Heubi JE, Barbacci MB, Zimmerman HJ: Therapeutic misadven- tures with acetaminophen: Hepatotoxicity after multiple doses in chil- dren. J Pediatr 1998; 132:22-7 R ~s 1976, 20:450-2 1995; 5:237-42

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Metadata

Authors
Korpela, R., Korvenoja, P., & Meretoja, O. A.
Affiliations
University of Helsinki (FI)
Venue
Anesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1999-08-01
Volume
91
Issue
2
Pages
442-447
ISSN
0003-3022 (ISSN-L)
DOI
10.1097/00000542-199908000-00019
OpenAlex
W2089757364
Cited by
230
References
31
Citations by year
2025: 1 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 7 · 2018: 8 · 2017: 6 · 2016: 2 · 2015: 5 · 2014: 7 · 2013: 9 · 2012: 4
FWCI
14.65
Type
journal article
Language
en
Open access
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
morphine-sparing effect, postoperative pain, opioid-sparing analgesia, dose-response relationship, postoperative nausea and vomiting, rescue analgesia, sevoflurane anesthesia, children, nonsteroidal anti-inflammatory drugs, rectal analgesia
MeSH terms
Acetaminophen, Ambulatory Surgical Procedures, Analgesics, Opioid, Child, Child, Preschool, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Infant, Male, Morphine, Postoperative Pain, Analgesics, Non-Narcotic

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