This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Bremerich, D. H. Articles by Behne, M. Search for Related Content PubMed PubMed Citation Articles by Bremerich, D. H. Articles by Behne, M.

---

PEDIATRIC ANESTHESIA

Prophylactically-Administered Rectal Acetaminophen Does Not Reduce Postoperative Opioid Requirements in Infants and Small Children Undergoing Elective Cleft Palate Repair

Clinics of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe-Universität Frankfurt, Germany

Address correspondence and reprint requests to Dorothee H. Bremerich, MD, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Address e-mail to Bremerich{at}em.uni-frankfurt.de

Rectal acetaminophen (Ac) is often administered prophylactically at anesthesia induction for postoperative pain management in small children and is thought to have an opioid-sparing effect. We assessed in this double-blinded, prospective, randomized study early opioid requirements after three doses of Ac (10, 20, and 40 mg/kg versus placebo) in 80 children (ASA physical status I, age 11.4 ± 9.9 mo) undergoing cleft palate repair. Single Ac plasma concentrations were measured. Pain scores assessed in the postanesthesia care unit of 4 of 10 resulted in the IV administration of 25 µg/kg piritramide, a popular European µ receptor agonist (lockout time, 10 min; maximum 0.125 mg/kg). There were no significant differences between groups with regard to the early postoperative pain scores and the overall cumulative IV opioid requirements. Maximal plasma concentrations achieved were only subtherapeutic (Ac 10 mg/kg: 8 µg/mL; Ac 20 mg/kg: 13 µg/mL; Ac 40 mg/kg: 21 µg/mL after 122, 122, and 121 min, respectively). We conclude that rectal Ac up to 40 mg/kg has no opioid-sparing effect, does not result in analgesic Ac plasma concentrations, and lacks proof of its efficacy in infants and small children undergoing cleft palate repair, whereas titrated IV opioid boluses produced rapid and reliable pain relief.

Implications: Acetaminophen is widely used prophylactically for postoperative analgesia in children and is thought to have an opioid-sparing effect. We showed that rectal acetaminophen up to 40 mg/kg administered at anesthesia induction lacked proof of efficacy, whereas IV opioid boluses resulted in reliable pain relief in children undergoing cleft palate repair.

This article has been cited by other articles:

				M. L Varela and M. A. Howland Single High-Dose Rectal Acetaminophen in Children Ann. Pharmacother., November 1, 2004; 38(11): 1935 - 1941. [Abstract] [Full Text] [PDF]

				C.L. SHEEN, J.F. DILLON, D.N. BATEMAN, K.J. SIMPSON, and T.M. MACDONALD Paracetamol toxicity: epidemiology, prevention and costs to the health-care system QJM, September 1, 2002; 95(9): 609 - 619. [Abstract] [Full Text] [PDF]

				D. Scolnik, E. Kozer, S. Jacobson, S. Diamond, and N. L. Young Comparison of Oral Versus Normal and High-Dose Rectal Acetaminophen in the Treatment of Febrile Children Pediatrics, September 1, 2002; 110(3): 553 - 556. [Abstract] [Full Text] [PDF]

				B. Anderson, D. H. Bremerich, and G. Neidhart Acetaminophen Analgesia in Infants Anesth. Analg., December 1, 2001; 93(6): 1626 - 1627. [Full Text] [PDF]