In newborns, oral or rectal paracetamol fails to reduce procedural pain, whereas intravenous paracetamol reduces morphine requirements after major surgery

Bührer, Christoph

doi:10.1136/ebmed-2016-110400

Cited by 1 publication

(2 citation statements)

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“…It is important to realize that the available information strongly suggests that paracetamol fails to reduce acute procedural [skinbreaking procedures like heel lancing or peripherally inserted central catheter (PICC) placement and ROP screening] pain (58,59). To further illustrate this, we have summarized the available information on heel lancing (60-63) and ROP (64-66) screening (Tables 3, 4).…”

Section: Paracetamol For Acute Procedural Analgesia In Neonatesmentioning

confidence: 99%

“…Paracetamol fails to reduce acute procedural pain in neonates (58,59), but this should be put in some perspective. The observation on, e.g., circumcision instructs us that paracetamol does not improve pain scores in the first 6 h after the intervention, but the paracetamol group scored better afterwards (>6 h) (55).…”

Section: Paracetamol For Acute Procedural Analgesia In Neonatesmentioning

confidence: 99%

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A Critical Review on the Relevance of Paracetamol for Procedural Pain Management in Neonates

Allegaert

2020

Front. Pediatr.

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Effective and safe pain relief in neonates matters. This is not only because of ethical constraints or human empathy, but even more because pain treatment is an important and crucial part of contemporary medical, paramedical, and nursing care to improve the outcome in neonatal intensive care graduates. Paracetamol (acetaminophen) is likely one of the pharmacological tools to attain this, with data on prescription practices suggesting that paracetamol is somehow the "rising star" in neonatal pain management. Besides very rare topical clinical scenarios like peripartal asphyxia and subsequent whole body hypothermia or the use of cardiorespiratory support devices, data on paracetamol pharmacokinetics and metabolism were reported throughout neonatal age or weight ranges, and we have summarized these data. In this review, we subsequently aimed to provide the reader with the currently available observations on the use of paracetamol as analgesic for different pain syndromes (major surgery, minor surgery or trauma, and procedural pain), with focus on the limitations of paracetamol when prescribed for neonatal procedural pain management. We hereby intentionally will not discuss other indications (patent ductus arteriosus and fever) for paracetamol administration in neonates. Based on the available evidence, paracetamol has opioid-sparing effects for major pain syndromes, is effective to treat minor to moderate pain syndromes, but fails for effective procedural pain management in neonates. This efficacy failure for procedural pain management should stimulate us to continue to search for more effective interventions, including non-pharmacological interventions and preventive strategies. Furthermore, there are also upcoming association type of epidemiological studies on the relation between exposure to analgesics-including paracetamol-and the negative short-or long-term outcome characteristics (neuro-behavioral, atopy, and fertility). Consequently and in addition to the search for effective alternatives to prevent or treat pain, studies on long-term outcome following paracetamol exposure are needed to inform all stakeholders on the full effect-side effect balance of the different strategies to treat pain.

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Section: Paracetamol For Acute Procedural Analgesia In Neonatesmentioning

confidence: 99%

Section: Paracetamol For Acute Procedural Analgesia In Neonatesmentioning

confidence: 99%