Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy †

Viitanen, Hanna; Tuominen, Netta; Vääräniemi, H.; Nikanne, Elina; Annila, P.

doi:10.1093/bja/aeg196

Cited by 77 publications

(70 citation statements)

References 28 publications

(7 reference statements)

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“…17 Those authors emphasized the importance of scheduling follow-up evaluations for combination therapy that extend beyond the immediate postoperative period. This may explain the finding of Viitanen et al that superiority of the combination was evident only following discharge from hospital 14 as well as our own result that a requirement for post-discharge rescue medication was eliminated for children receiving the combination. Mean Difference vs Combination (95% CI for difference) -0.9 (-6.2 to 4.5) -4.6 (-9.9 to 0.67)…”

Section: Limitationssupporting

confidence: 67%

“…14 Results of all three studies showed the combination treatment to be superior to acetaminophen alone, although studies comparing the combination treatment with ibuprofen alone showed conflicting results. 14,16 These conclusions are inconsistent with our data showing no difference between the three treatments with regard to the primary outcome measure. Our secondary findings are more aligned with this previous work.…”

Section: Discussionmentioning

confidence: 99%

“…8 Data pertaining to children are limited to three studies using a variety of pain assessment techniques and outcome measures in tonsillectomy and dental pain models. [14][15][16] All of these studies assessed the combination of acetaminophen and ibuprofen using a single-dose design, and one used a rectal route of administration. 14 Results of all three studies showed the combination treatment to be superior to acetaminophen alone, although studies comparing the combination treatment with ibuprofen alone showed conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] All of these studies assessed the combination of acetaminophen and ibuprofen using a single-dose design, and one used a rectal route of administration. 14 Results of all three studies showed the combination treatment to be superior to acetaminophen alone, although studies comparing the combination treatment with ibuprofen alone showed conflicting results. 14,16 These conclusions are inconsistent with our data showing no difference between the three treatments with regard to the primary outcome measure.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children

Merry

Edwards

Ahmad

et al. 2013

Can J Anesth/J Can Anesth

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Section: Limitationssupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children

Merry

Edwards

Ahmad

et al. 2013

Can J Anesth/J Can Anesth

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“…Oztekin et al also reported that pre-emptive rectal diclofenac reduced postoperative pain intensity and PCA morphine requirements of children anaesthetised with remifentanil for tonsillectomy [19]. Viitanen et al demonstrated that the total morphine used was significantly less in groups receiving paracetamol, ibuprofen or their combination compared to those receiving placebo for paediatric adenoidectomy, but the combination offered insignificant improvement in analgesia [20].…”

Section: Discussionmentioning

confidence: 99%

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Riad

Moussa

2007

Anaesthesia

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SummaryBoth rectal diclofenac and paracetamol are commonly used to treat acute postoperative pain in children but combining them to improve the quality of analgesia is controversial. This study aimed to detect whether the pre-operative combined administration of rectal diclofenac and paracetamol is superior to either drug alone. One hundred and eight patients were randomly assigned to receive either rectal diclofenac 1 mg.kg )1 or paracetamol 40 mg.kg )1 or their combination 1 h prior to surgery. In the first 24 h postoperatively, pain was assessed using the Wong and Baker Pain Scale. If the patients experienced a pain score of 2 or more, morphine was given. The total dose of morphine and number of doses required were recorded. Children who received the rectal diclofenac-paracetamol combination experienced a lower pain scale and a decreased need for morphine compared with children receiving each drug alone.

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Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy †

Cited by 77 publications

References 28 publications

Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children

Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

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