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Comparison of preemptive intravenous paracetamol and caudal block in terms of analgesic and hemodynamic parameters in children

Year 2012, , 202 - 208, 01.06.2012
https://doi.org/10.5799/ahinjs.01.2012.02.0145

Abstract

Objectives: Paracetamol has a widespread use for fever and symptomatic relief of pain in children. The aim of this study was to compare analgesic effects of preemptive intravenous (i.v.) paracetamol, and caudal block with levobupivacaine. Materials and methods: A total of 60 children with ASA I-II physical status, aged 5-15 years and undergoing inguinal hernia repair, were randomly allocated to three groups so that each group contained 20 patients. Group P children received i.v. 15mg/kg paracetamol. Group C received only caudal block with levobupivacaine, and Group PC received both i.v. paracetamol, and caudal block with levobupivacaine. Pain level assessed by modified Eastern Ontario Children\'s Hospital pain scale (mCHEOPs), sedation status by Ramsey sedation scale at postoperative 5, 15, 30 min and 1,3, and 6th hours. Results: No significant differences were found in age, gender distribution, body weight, ASA status, type and duration of surgery between three groups (p>0.05). Although significant difference were found in mCHEOPs scores within groups by repeated measures, no difference of pain scores was observed between three groups (p>0.05). There were no significant differences in the hemodynamic parameters (heart rate, blood pressure) both within groups and between groups (p>0.05). Conclusions: Preemptive intravenous paracetamol had similar analgesic effects compared with caudal block with levobupivacaine with regard to postoperative pain scores in children undergoing inguinal hernia repair. No hemodynamic or other adverse effects were observed with intravenous paracetamol. J Clin Exp Invest 2012; 3(2): 202-208

References

  • Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002; 96(3):725-41.
  • Arıcı S, Gurbet A, Türker G, Yavaşcaoğlu B, Şahin Ş. Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Ağrı 2009; 21(1): 54-61.
  • Erbay H, Gönüllü M. Preemptive analgesia in pediatric surgical patients. T Klin J Med Sci 2001; 21(3): 319-23.
  • Aida S, Baba H, Yamakura T, Taga K, Fukura S. The effectiveness of preemptive analgesia varies according to the type of surgery. Anesth Analg 1999; 89(6): 711-6.
  • Toygar P, Akaya T, Özkan D, Özel Ö, Uslu E, Gümüş H. [Does iv parocetamol hove preemptive analgesic effect on lumber disc surgeries?]. Ağrı 2008; 20(1):14-9.
  • Kumpulainen E, Kokki H, Halonen T, Heikkinen M, Savolainen J, Laisalmi M. Paracetamol (acetaminophen) penetrates readily into the cerebrospinal fluid of children after intravenous administration. Pediatrics 2007; 119(7):766-71.
  • Hahn TW, Henneberg SW, Holm-Knudsen RJ, Eriksen K, Rasmussen SN, Rasmussen M. Pharmacokinetics of rectal paracetamol after repeated dosing in children. Br J Anaesth 2000; 85(4):512-9.
  • Talu G.K, Özyalçın N.S, Balsak R, Karadeniz M. The efficacy of preemptive ketamine and ropivacaine in pediatric patients: A placebo controlled double-blind trial. Ağrı 2008; 20(1):31-6.
  • Murat I, Baujard C, Foussat C, et al. Tolerance and analgesic efficacy of a new i.v. paracetamol solution in children after inguinal hernia repair. Paediatr Anaesth 2005; 15(6):663-70.
  • Alhashemi JA, Daghistani MF. Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on posttonsillectomy pain in children. Br J Anaesth 2006; 96(7):790-5.
  • Alhashemi JA, Daghistani MF. Effect of intraoperative intravenous acetaminophen vs. intramuscular meperidine on pain and discharge time after paediatric dental restoration. Eur J Anaesthesiol 2007; 24(1):128-33.
  • Capici F, Ingelmo PM, Davidson A, et al. Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children. Br J Anaesth 2008; 100(2):251-5.
  • Dahl J, Moiniche S. Pre-emptive analgesia. Br Med Bulletin 2004; 71(1): 13-27.
  • Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund A. Onset of asetaminophen analgesia: comparision of oral and intravenous routes after third molar surgery. Brit J Anaesth 2005; 94: 642-8.
  • Anderson BJ, Pons G, Autret-Leca E, Allegaert K, Boccard E. Pediatric intravenous paracetamol (propacetamol) pharmacokinetics: a population analysis. Paediatr Anaesth 2005; 15(2):282-92.
  • Dahl V, Raeder J.C. Non-opioid postoperative analgesia. Acta Anaesthesiol Scand 2000; 44(10): 1191-203.
  • Hynes D, McCarrol M, Hiesse-Provost O. Analgesic efficacy of parenteral paracetamol and diclofenac in postoperative orthopaedic pain. Acta Anaesthesiol Scand 2006; 50(3):374-81.
  • Landwehr S, Kiencke P, Giesecke T, Eggert D, Thumann G, Kampe S. A comparison between iv paracetamol and metamizol for postoperative analgesia after retinal surgery. Curr Med Res Opin 2005; 21(13): 1569-75.
  • Benson GD Acetaminophen in chronic liver disease. Clin Pharmacol Ther 1983; 33(1): 95-101.
  • Bjorkman D. Nonsteroidal anti-inflammatory drug-associated toxicity of the liver, gastrointestinal tract and esophagus. Am J Med 1998; 105: 17S-21S.
  • Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol 2006; 72(4):453-9.
  • Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005; 100(7):757-73.
  • Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children. Anesth Analg 1998; 87(1):52-6.
  • Holthusen H, Eichwede F, Stevens M, Willnow U, Lipfert P. Pre-emptive analgesia: comparison of preoperative with postoperative caudal block on postoperative pain in children. Br J Anaesth 1994; 73(4):440-2.
  • Rice LJ, Pudimat MA, Hannallah RS. Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients. Can J Anaesth 1990; 37(4 Pt 1):429-31.
  • Aydoğan H, Doğru K, Erdem Ş, Biçer C, Aksu R, Boyacı A. [The effect of iv paracetamol on the hemodynamic indices, liver functions and the postoperative analgesia in the patients underwent major orthopaedic surgery]. Erciyes Medical Journal 2008; 30(1):71-7.

Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması

Year 2012, , 202 - 208, 01.06.2012
https://doi.org/10.5799/ahinjs.01.2012.02.0145

Abstract

Amaç: Parasetamol çocuklarda ateş ve akut ağrının
semptomatik tedavisi amacıyla yaygın bir şekilde kullanılmaktadır.
Bu çalışmada preemptif analjezi amacıyla
verilen intravenöz (i.v.) parasetamolü, kaudal blok uygulamasıyla
karşılaştırmayı amaçladık.
Gereç ve yöntem: Alt batın cerrahisi operasyonlarında
fiziksel durumu ASA I-II olan, 5-15 yaşlarında 60 çocuk
rastgele bir şekilde 20’şer çocuktan oluşan 3 gruba ayrıldı.
Grup P’ ye i.v. 15 mg/kg parasetamol verildi ve salinle
kaudal blok yapıldı, Grup K’ ya sadece levobupivakainle
kaudal blok yapıldı; Grup PK’ya ise hem i.v. parasetamol
verildi hem de levobupivakainle kaudal blok yapıldı. Bütün hastalara aynı anestezi tekniği uygulandı. Hastaların
ağrısı, Modifiye Eastern Ontario Cocuk Hastanesi ağrı
skalası (mCHEOPS) ile, sedasyon durumu ise Ramsey
Sedasyon Skalasına göre postoperatif 5, 15, 30. dakikalarda
ve 1, 3 ve 6. saatlerde değerlendirildi. İlk analjezik
gereksinim zamanları kaydedildi.
Bulgular: Gruplar arasında yaş, cinsiyet, vücut ağırlığı,
ASA durumu, ameliyat tipleri ve ameliyat süreleri bakımından anlamlı bir fark bulunmadı (p > 0.05). Ağrı skorları
bakımından grup içi değişimi anlamlı farklı bulunmakla
birlikte (p < 0.05) gruplar arasında istatistiksel bir farklılık
saptanmadı (p > 0.05). Tüm gruplarda mCHEOPS puanlarını
en yüksek düzeye postoperatif 15. dakikada ulaştı.
Gruplar arasında çeşitli zamanlarda elde edilen postoperatif
sedasyon skorları karşılaştırıldığında anlamlı bir farklılık
bulunmadı (p > 0.05). Hemodinamik veriler (kalp hızı,
kan basınçları) değerlendirildiğinde ortalama kan basıncı
ve kalp atım hızlarında grup içi ölçümlerde ve gruplar arasında
anlamlı bir farklılık saptanmadı (p > 0.05).
Sonuç: Çocuklardaki alt batın cerrahilerinde preemptif
olarak uygulanan intravenöz parasetamol ve kaudal bloğun benzer biçimde postoperatif ağrı skorlarını azalttığı
bulunurken herhangi bir yan etki ve olumsuz hemodinamik
etkiye rastlanmadı.

References

  • Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002; 96(3):725-41.
  • Arıcı S, Gurbet A, Türker G, Yavaşcaoğlu B, Şahin Ş. Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Ağrı 2009; 21(1): 54-61.
  • Erbay H, Gönüllü M. Preemptive analgesia in pediatric surgical patients. T Klin J Med Sci 2001; 21(3): 319-23.
  • Aida S, Baba H, Yamakura T, Taga K, Fukura S. The effectiveness of preemptive analgesia varies according to the type of surgery. Anesth Analg 1999; 89(6): 711-6.
  • Toygar P, Akaya T, Özkan D, Özel Ö, Uslu E, Gümüş H. [Does iv parocetamol hove preemptive analgesic effect on lumber disc surgeries?]. Ağrı 2008; 20(1):14-9.
  • Kumpulainen E, Kokki H, Halonen T, Heikkinen M, Savolainen J, Laisalmi M. Paracetamol (acetaminophen) penetrates readily into the cerebrospinal fluid of children after intravenous administration. Pediatrics 2007; 119(7):766-71.
  • Hahn TW, Henneberg SW, Holm-Knudsen RJ, Eriksen K, Rasmussen SN, Rasmussen M. Pharmacokinetics of rectal paracetamol after repeated dosing in children. Br J Anaesth 2000; 85(4):512-9.
  • Talu G.K, Özyalçın N.S, Balsak R, Karadeniz M. The efficacy of preemptive ketamine and ropivacaine in pediatric patients: A placebo controlled double-blind trial. Ağrı 2008; 20(1):31-6.
  • Murat I, Baujard C, Foussat C, et al. Tolerance and analgesic efficacy of a new i.v. paracetamol solution in children after inguinal hernia repair. Paediatr Anaesth 2005; 15(6):663-70.
  • Alhashemi JA, Daghistani MF. Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on posttonsillectomy pain in children. Br J Anaesth 2006; 96(7):790-5.
  • Alhashemi JA, Daghistani MF. Effect of intraoperative intravenous acetaminophen vs. intramuscular meperidine on pain and discharge time after paediatric dental restoration. Eur J Anaesthesiol 2007; 24(1):128-33.
  • Capici F, Ingelmo PM, Davidson A, et al. Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children. Br J Anaesth 2008; 100(2):251-5.
  • Dahl J, Moiniche S. Pre-emptive analgesia. Br Med Bulletin 2004; 71(1): 13-27.
  • Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund A. Onset of asetaminophen analgesia: comparision of oral and intravenous routes after third molar surgery. Brit J Anaesth 2005; 94: 642-8.
  • Anderson BJ, Pons G, Autret-Leca E, Allegaert K, Boccard E. Pediatric intravenous paracetamol (propacetamol) pharmacokinetics: a population analysis. Paediatr Anaesth 2005; 15(2):282-92.
  • Dahl V, Raeder J.C. Non-opioid postoperative analgesia. Acta Anaesthesiol Scand 2000; 44(10): 1191-203.
  • Hynes D, McCarrol M, Hiesse-Provost O. Analgesic efficacy of parenteral paracetamol and diclofenac in postoperative orthopaedic pain. Acta Anaesthesiol Scand 2006; 50(3):374-81.
  • Landwehr S, Kiencke P, Giesecke T, Eggert D, Thumann G, Kampe S. A comparison between iv paracetamol and metamizol for postoperative analgesia after retinal surgery. Curr Med Res Opin 2005; 21(13): 1569-75.
  • Benson GD Acetaminophen in chronic liver disease. Clin Pharmacol Ther 1983; 33(1): 95-101.
  • Bjorkman D. Nonsteroidal anti-inflammatory drug-associated toxicity of the liver, gastrointestinal tract and esophagus. Am J Med 1998; 105: 17S-21S.
  • Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol 2006; 72(4):453-9.
  • Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005; 100(7):757-73.
  • Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children. Anesth Analg 1998; 87(1):52-6.
  • Holthusen H, Eichwede F, Stevens M, Willnow U, Lipfert P. Pre-emptive analgesia: comparison of preoperative with postoperative caudal block on postoperative pain in children. Br J Anaesth 1994; 73(4):440-2.
  • Rice LJ, Pudimat MA, Hannallah RS. Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients. Can J Anaesth 1990; 37(4 Pt 1):429-31.
  • Aydoğan H, Doğru K, Erdem Ş, Biçer C, Aksu R, Boyacı A. [The effect of iv paracetamol on the hemodynamic indices, liver functions and the postoperative analgesia in the patients underwent major orthopaedic surgery]. Erciyes Medical Journal 2008; 30(1):71-7.
There are 26 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Serbülent Gökhan Beyaz This is me

Publication Date June 1, 2012
Published in Issue Year 2012

Cite

APA Beyaz, S. G. (2012). Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması. Journal of Clinical and Experimental Investigations, 3(2), 202-208. https://doi.org/10.5799/ahinjs.01.2012.02.0145
AMA Beyaz SG. Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması. J Clin Exp Invest. June 2012;3(2):202-208. doi:10.5799/ahinjs.01.2012.02.0145
Chicago Beyaz, Serbülent Gökhan. “Çocuklarda Analjezik Ve Hemodinamik Parametreler açısından Preemptif intravenöz Parasetamol Ve Kaudal bloğun karşılaştırılması”. Journal of Clinical and Experimental Investigations 3, no. 2 (June 2012): 202-8. https://doi.org/10.5799/ahinjs.01.2012.02.0145.
EndNote Beyaz SG (June 1, 2012) Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması. Journal of Clinical and Experimental Investigations 3 2 202–208.
IEEE S. G. Beyaz, “Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması”, J Clin Exp Invest, vol. 3, no. 2, pp. 202–208, 2012, doi: 10.5799/ahinjs.01.2012.02.0145.
ISNAD Beyaz, Serbülent Gökhan. “Çocuklarda Analjezik Ve Hemodinamik Parametreler açısından Preemptif intravenöz Parasetamol Ve Kaudal bloğun karşılaştırılması”. Journal of Clinical and Experimental Investigations 3/2 (June 2012), 202-208. https://doi.org/10.5799/ahinjs.01.2012.02.0145.
JAMA Beyaz SG. Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması. J Clin Exp Invest. 2012;3:202–208.
MLA Beyaz, Serbülent Gökhan. “Çocuklarda Analjezik Ve Hemodinamik Parametreler açısından Preemptif intravenöz Parasetamol Ve Kaudal bloğun karşılaştırılması”. Journal of Clinical and Experimental Investigations, vol. 3, no. 2, 2012, pp. 202-8, doi:10.5799/ahinjs.01.2012.02.0145.
Vancouver Beyaz SG. Çocuklarda Analjezik ve hemodinamik parametreler açısından preemptif intravenöz parasetamol ve kaudal bloğun karşılaştırılması. J Clin Exp Invest. 2012;3(2):202-8.