A Comparison of The Effects of Pre-Emptive and Intraoperative Intravenous Acetaminophen Administration on Pain Management After Circumcision

Abstract

Aim: The aim of this study was to compare the efficacy of the pre-emptive and intraoperative use of intravenous acetaminophen in post-circumcision pain in children. Methods: The records of patients who had undergone circumcision were retrospectively evaluated using our database in the Samsun University, Samsun Training and Research Hospital, Department of Pediatric Surgery, Turkey, from May 2021 to May 2022. Patients were divided into two groups based on administration of pre-emptive (Group 1) and intraoperative (Group 2) acetaminophen. Baseline characteristics, vital signs, outcomes, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores were then compared between the groups. Results: Two hundred four patients, 95 (46.6%) in Group 1 and 109 (53.4%) in Group 2, were enrolled in the study. No significant difference was determined in terms of mean body mass index, age, length of stay in the recovery room, operative time, or length of hospital stay. Vital findings exhibited no difference in preoperative, induction, intraoperative, or postoperative recordings. Significant differences were observed between the groups’ mean pain scores 30 minutes after surgery (p = 0.024). However, no such significant differences were observed at one and three hours after surgery (p = 0.063 and p = 0.708, respectively). Rescue analgesia was performed in 13 (13.7%) cases in Group 1 and 17 (15.6%) in Group 2 (p = 0.7). Conclusions: Pre-emptive intravenous acetaminophen reduced pain 30 minutes after circumcision. Pre-emptive and intraoperative use of acetaminophen resulted in similar and acceptable efficacy in pain relief one and three hours after surgery.

Keywords

• Acetaminophen
• analgesia
• circumcision
• pain
• pediatrics
• pre-empitive

Sünnet Ağrısı Kontrolünde Intravenöz Asetamınofenın Preemptıf ve Intraoperatıf Uygulamasının Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı, çocuklarda postoperatif sünnet ağrı palyasyonunda intravenöz asetaminofenin preemptif ve intraoperatif kullanımının etkinliğini karşılaştırmaktır. Yöntemler: Samsun Üniversitesi, Samsun Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi Anabilim Dalı'nda Mayıs 2021-Mayıs 2022 tarihleri arasında veri tabanımız kullanılarak sünnet yapılan hastaların kayıtları geriye dönük olarak değerlendirildi. Hastalar asetaminofen uygulama zamanına göre preemptif (Grup 1) ve intraoperatif (Grup 2) olmak üzere iki gruba ayrıldı. Çocukların sosyodemografik özellikleri, klinik ve vital bulguları ile Yüz, Bacaklar, Aktivite, Ağlama ve Teselli Edilebilirlik (FLACC) ölçeği gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya Grup 1'de 95 (%46,6) ve Grup 2'de 109 (%53,4) olmak üzere toplam 204 hasta alındı. Gruplar arasında yaş ortalaması, vücut kitle indeksi, derlenme odasında kalış süresi, ameliyat süresi ve hastanede kalış süreleri açısından anlamlı fark saptanmadı. Vital bulgular, preoperatif, indüksiyon, intraoperatif ve postoperatif dönemlerde farklılık göstermedi. Grupların ameliyattan 30 dakika sonra ortalama ağrı skorları arasında anlamlı fark gözlendi (p = 0.024). Ancak ameliyattan bir ve üç saat sonraki ortalama ağrı skorları arasında anlamlı fark gözlenmedi (sırasıyla, p = 0,063 ve p = 0,708). Grup 1'de 13 (%13,7) ve Grup 2'de 17 (%15,6) hastaya ek analjezi uygulandı (p=0,7). Sonuç: Çocuklarda sünnet sonrası intravenöz asetaminofen kullanımı güvenlidir ve iyi tolere edilmektedir. Her ne kadar preemptif asetaminofen, postoperatif ilk 30 dakikada daha üstün bir analjezi sağlasa da, ameliyattan sonra ki birinci ve üçüncü saatlerde, asetaminofenin preemptif ve intraoperatif kullanımının ağrının giderilmesinde benzer ve kabul edilebilir bir etkinliğe sahiptir.

Anahtar Kelimeler

• Asetaminofen
• ağrı
• analjezi
• pediatri
• preemptif
• sünnet

Kaynakça

1. 1. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130(3):e756-85. doi: 10.1542/peds.2012-1990
2. 2. Gologram M, Margolin R, Lomiguen CM. Need for Increased Awareness of International Male Circumcision Variations and Associated Complications: A Contemporary Review. Cureus. 2022;14(4):e24507. doi: 10.7759/cureus.24507
3. 3. Vittinghoff M, Lönnqvist PA, Mossetti V, et al. Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative). Paediatr Anaesth. 2018;28:493–506. doi: 10.1111/pan.13373
4. 4. Xuan C, Yan W, Wang D, et al. Effect of Preemptive Acetaminophen on Opioid Consumption: A Meta-Analysis. Pain Physician. 2021;24(2):E153-E160. doi: N/A
5. 5. Kissin I. Preemptive analgesia. Anesthesiology. 2000;93:1138–43. doi: 10.1097/00000542-200010000-00040
6. 6. Akdeniz E, Bolat MS, Akdeniz S. Postoperative Pain Management in Urology. J Clin Anal Med. 2016;7(1):144-8. doi: 10.4328/jcam.4013
7. 7. Khalili GR, Shafa A, Yousefi R. Comparison of the effects of preemptive intravenous and rectal acetaminophen on pain management after inguinal herniorrhaphy in children: a placebo-controlled study. Middle East J Anaesthesiol. 2016;23(5):543-8. doi: N/A
8. 8. Sandeep V, Kumar M, Jyostna P, et al. Evaluation of 2-stage injection technique in children. Anesth Prog. 2016;63:3–7. doi: 10.2344/0003-3006-63.1.3

9. 9. Munevveroglu C, Gunduz M. Postoperative pain management for circumcision; Comparison of frequently used methods. Pak J Med Sci. 2020;36(2):91-95. doi: 10.12669/pjms.36.2.505
10. 10. McNicol ED, Tzortzopoulou A, Cepeda MS, et al. Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2011;106(6):764-75. doi: 10.1093/bja/aer107. 10.1093/bja/aer107
11. 11. Hyland SJ, Brockhaus KK, Vincent WR, et al. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel). 2021;9(3):333. doi: 10.3390/healthcare9030333
12. 12. Zieliński J, Morawska-Kochman M, Dudek K, et al. The Effect of Pre-Emptive Analgesia on the Postoperative Pain in Pediatric Otolaryngology: A Randomized, Controlled Trial. J Clin Med. 2022;11(10):2713. doi: 10.3390/jcm11102713
13. 13. Kano K, Kawamura K, Miyake T. Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective, single-blind, randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2021;26(1):e64-e70. doi: 10.4317/medoral.23983
14. 14. Soyer T, Büyükkoçak Ü, Cesur Ö, et al. Comparison of Rectal and Parenteral Paracetamol Administration in Pain Control After Circumcision. KÜ Tıp Fak Derg. 2008;10(1): 36-41. doi: N/A
15. 15. Bellieni CV, Alagna MG, Buonocore G. Analgesia for infants' circumcision. Ital J Pediatr. 2013;39:38. doi: 10.1186/1824-7288-39-38
16. 16. van der Westhuizen J, Kuo PY, Reed PW, et al. Randomised controlled trial comparing oral and intravenous paracetamol (acetaminophen) plasma levels when given as preoperative analgesia. Anaesth Intensive Care. 2011;39(2):242-6. doi: 10.1177/0310057X1103900214
17. 17. Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth. 2002;88(2):215-26. doi: 10.1093/bja/88.2.215
18. 18. Pasero C, Stannard D. The role of intravenous acetaminophen in acute pain management: a case-illustrated review. Pain Manag Nurs. 2012;13(2):107-24. doi: 10.1016/j.pmn.2012.03.002