Effects of Prophylactic Rectal versus Oral Acetaminophen on Postoperative Conditions in Pediatric Adenotonsillectomy Patients: A Randomized Clinical Trial
AbstractBackground: The role of premedication with acetaminophen on postoperative conditions in pediatric patients is not well known. We aimed to assess the effects of prophylactic oral versus rectal acetaminophen on postoperative conditions in pediatric adenotonsillectomy patients.Methods: In a double-blinded randomized clinical trial, 127 children undergoing adenotonsillectomies were randomized to receive either acetaminophen syrup 15 mg/kg (PO group) half an hour before surgery, or acetaminophen suppository 15 mg/kg (PR group) at anesthesia induction. Both groups received dexamethasone 0.1 mg/kg before surgery as an antiemetic and underwent the same general anesthesia management. Postoperative pain was evaluated using the face, legs, activity, cry, consolability (FLACC) scale every 30 min during the first 2 h and every 1 h until 4 h after surgery. Child with a FLACC scale > 3 received rescue medication of acetaminophen syrup 5 mg/kg orally.Results: The two groups were not significantly different with respect to patients’ demographics and anesthesia duration. FLACC scales in each time points were similar to each other between the studied groups. Although total postoperative acetaminophen syrup consumption and percentage of nausea or vomiting were lower in the PR group, the differences were not statistically different. The oral feeding starting time was significantly lower in the PR group in comparison with the PO group (p< 0.01).Conclusion: We conclude that prophylactic rectal administration of acetaminophen at anesthesia induction has several beneficial impacts on postoperative conditions in children undergoing adenotonsillectomies.
Dashti GA, Amini S, Zanguee E. The prophylactic effect of rectal acetaminophen on postoperative pain and opioid requirements after adenotonsillectomy in children. Middle East J Anaesthesiol. 2009; 20(2):245-9.
Pickering AE, Bridge HS, Nolan J, Stoddart PA. Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth. 2002; 88(1):72-7.
Owczarzak V, Haddad J Jr. Comparison of oral versus rectal administration of acetaminophen with codeine in postoperative pediatric adenotonsillectomy patients. Laryngoscope. 2006; 116(8):1485-8.
Korpela R, Korvenoja P, Meretoja OA. Morphine-sparing effect of acetaminophen in pediatric day-case surgery. Anesthesiology. 1999; 91(2):442-7.
Issioui T, Klein KW, White PF, Watcha MF, Coloma M, Skrivanek GD, et al. The efficacy of premedication with celecoxib and acetaminophen in preventing pain after otolaryngologic surgery. Anesth Analg. 2002; 94(5):1188-93.
Hiller A, Silvanto M, Savolainen S, Tarkkila P. Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy. Acta Anaesthesiol Scand. 2004; 48(9):1185-9.
Viitanen H, Tuominen N, Vääräniemi H, Nikanne E, Annila P. Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy. Br J Anaesth. 2003; 91(3):363-7.
Bremerich DH, Neidhart G, Heimann K, Kessler P, Behne M. Prophylactically-administered rectal acetaminophen does not reduce postoperative opioid requirements in infants and small children undergoing elective cleft palate repair. Anesth Analg. 2001; 92(4):907-12.
Gaudreault P, Guay J, Nicol O, Dupuis C. Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen. Can J Anaesth. 1988; 35(2):149-52.
Anderson B, Kanagasundarum S, Woollard G. Analgesic efficacy of paracetamol in children using tonsillectomy as a pain model. Anaesth Intensive Care. 1996; 24(6):669-73.
Kotiniemi LH, Ryhänen PT, Valanne J, Jokela R, Mustonen A, Poukkula E. Postoperative symptoms at home following day-case surgery in children: a multicentre survey of 551 children. Anaesthesia. 1997; 52(10):963-9.
Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatoxicity after multiple doses in children. J Pediatr. 1998; 132(1):22-7.
Rivera-Penera T, Gugig R, Davis J, McDiarmid S, Vargas J, Rosenthal P, et al. Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity. J Pediatr. 1997; 130(2):300-4.
Miles FK, Kamath R, Dorney SF, Gaskin KJ, O'Loughlin EV. Accidental paracetamol overdosing and fulminant hepatic failure in children. Med J Aust. 1999; 171(9):472-5.
Eguia L, Materson BJ. Acetaminophen-related acute renal failure without fulminant liver failure. Pharmacotherapy. 1997; 17(2):363-70.
Sepponen K, Kokki H, Ahonen R. Training of medical staff positively influences postoperative pain management at home in children. Pharm World Sci. 1999; 21(40):168-72.
Vons KM, Bijker JB, Verwijs EW, Majoor MH, de Graaff JC. Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children. Paediatr Anaesth. 2014; 24(5):476-82.
Scalford D, Flynn-Roth R, Howard D, Phillips E, Ryan E, Davis KF, et al. Pain management of children aged 5 to 10 years after adenotonsillectomy. J Perianesth Nurs. 2013; 28(6):353-60.
Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab-Tafti S, Reid D, et al. Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015; 135(2):307-13.