Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T01:49:57.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of intraoperative intravenous acetaminophen vs. intramuscular meperidine on pain and discharge time after paediatric dental restoration

Published online by Cambridge University Press:  08 August 2006

J. A. Alhashemi  and
M. F. Daghistani
J. A. Alhashemi
Affiliation:
King Abdulaziz Medical City, Department of Anesthesia, Jeddah, Saudi Arabia
M. F. Daghistani
Affiliation:
King Abdulaziz Medical City, Department of Anesthesia, Jeddah, Saudi Arabia
Get access

Abstract

Summary

Background and objective: Enteral acetaminophen (paracetamol) has limited analgesic efficacy due to its delayed absorption and sub-therapeutic plasma concentration. Intravenous (i.v.) acetaminophen solves this issue and could thus provide adequate analgesia as a single agent. We compared intraoperative i.v. acetaminophen with intramuscular (i.m.) meperidine with regard to postoperative analgesia and readiness for discharge in paediatric patients undergoing day care dental restoration. Methods: Forty children were randomized, in this double-blind study, to receive acetaminophen 15 mg kg−1 i.v. (Group A) or meperidine 1 mg kg−1 i.m. (Group M) after anaesthesia induction and before surgery. All patients received midazolam 0.5 mg kg−1 orally 30 min preoperatively and fentanyl 1 μg kg−1 i.v. immediately after induction. Anaesthesia was induced with either sevoflurane inhalation or propofol 3 mg kg−1 i.v. and was maintained with sevoflurane. Postoperatively, the objective pain scale, Ramsay sedation score, and Aldrete score were determined every 5 min until readiness for recovery room discharge (defined as achieving an Aldrete score of 10). Results: Group A had slightly higher pain scores during early recovery compared with Group M (estimated marginal means: 3 ± SEM 0.4 vs. 2 ± SEM 0.4, respectively (95% CI for difference: 0.4, 2.6), P = 0.012 for F-test). In contrast, Ramsay scores were higher in Group M than in Group A during assessment period (estimated marginal means: 4 ± SEM 0.3 vs. 2 ± SEM 0.4, respectively (95% CI for difference: −2.3, −0.3), P = 0.013 for F-test). Group A patients achieved an Aldrete score of 10 sooner than those in Group M (5 ± SEM 2 vs. 16 ± SEM 4 min, respectively (95% CI for difference: −9, −14), P = 0.009). Conclusion: Compared with i.m. meperidine, intraoperative i.v. acetaminophen resulted in slightly higher pain scores but earlier readiness for recovery room discharge in paediatric patients undergoing dental restoration. The potential economic benefit of early recovery room discharge needs to be further explored.

Keywords

NON-NARCOTIC ANALGESICS, acetaminophenNARCOTICS, meperidineANALGESIA, postoperative, pre-emptiveDENTAL RESTORATIONDENTAL CARIESPAEDIATRICSPATIENT DISCHARGE, recovery room
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 128 - 133
Copyright
2007 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atan S, Ashley P, Gilthorpe MS, Scheer B, Mason C, Roberts G. Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unit. Int J Paediatr Dent 2004; 14: 9–16.Google Scholar
Engelhardt T, Steel E, Johnston G, Veitch DY. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine. Paediatr Anaesth 2003; 13: 249–252.Google Scholar
Rusy LM, Houck CS, Sullivan LJet al. A double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding. Anesth Analg 1995; 80: 226–229.Google Scholar
Romsing J, Ostergaard D, Drozdziewicz D, Schultz P, Ravn G. Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients. Acta Anaesthesiol Scand 2000; 44: 291–295.Google Scholar
Freeman KO, Connelly NR, Schwartz D, Jacobs BR, Schreibstein JM, Gibson C. Analgesia for paediatric tonsillectomy and adenoidectomy with intramuscular clonidine. Paediatr Anaesth 2002; 12: 617–620.Google Scholar
Nielsen JC, Bjerring P, Arendt-Nielsen L, Petterson KJ. Analgesic efficacy of immediate and sustained release paracetamol and plasma concentration of paracetamol. Double blind, placebo-controlled evaluation using painful laser stimulation. Eur J Clin Pharmacol 1992; 42: 261–264.Google Scholar
Anderson BJ, Woolard GA, Holford NH. Pharmacokinetics of rectal paracetamol after major surgery in children. Paediatr Anaesth 1995; 5: 237–242.Google Scholar
Anderson BJ, Pons G, Autret-Leca E, Allegaert K, Boccard E. Pediatric intravenous paracetamol (propacetamol) pharmacokinetics: a population analysis. Paediatr Anaesth 2005; 15: 282–292.Google Scholar
Hannallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS. Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology 1987; 66: 832–834.Google Scholar
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ 1974; 2: 656–659.Google Scholar
Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7: 89–91.Google Scholar
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–934.Google Scholar
Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage 2003; 25: 406–411.Google Scholar
Dupont WD, Plummer JrWD. Power and sample size calculations for studies involving linear regression. Control Clin Trial 1998; 19: 589–601.Google Scholar
Murat I, Baujard C, Foussat Cet al. Paediatr Anaesth 2005; 15: 663–670.
Patel S, Vargo JJ, Khandwala Fet al. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005; 100: 2689–2695.Google Scholar
Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage 2003; 25: 406–411.Google Scholar
Van Aken H, Thys L, Veekman L, Buerkle H. Assessing analgesia in single and repeated administrations of propacetamol for postoperative pain: comparison with morphine after dental surgery. Anesth Analg 2004; 98: 159–165.Google Scholar
Schmitt M, Nazif MM, McKee KCet al. Pharmacokinetics and local responses to submucosal meperidine compared with other routes of administration. Pediatr Dent 1994; 16: 190–192.Google Scholar
Agrawal D, Feldman HA, Krauss B, Waltzman ML. Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children. Ann Emerg Med 2004; 43: 247–255.Google Scholar
Aneja R, Heard AM, Fletcher JE, Heard CM. Sedation monitoring of children by the bispectral index in the pediatric intensive care unit. Pediatr Crit Care Med 2003; 4: 60–64.Google Scholar
Enever GR, Nunn JH, Sheehan JK. A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities. Int J Paediatr Dent 2000; 10: 120–125.Google Scholar
Alhashemi JA, Miller DR, O'Brien HV, Hull KA. Cost-effectiveness of inhalational, balanced and total intravenous anaesthesia for ambulatory knee surgery. Can J Anaesth 1997; 44: 118–125.Google Scholar