ABSTRACT
An exploratory study in paediatric surgical patients was performed to describe the behaviour of a rectal solution of paracetamol at 20 mg/kg. Four of six patients were able to complete the study. Peak concentration (Cmax) and time to peak concentration (tmax) found in the children are comparable to adults studied earlier. After 1.6 hrs (tmax) a peak concentration of 11.7 mg/l (Cmax) was reached. The area under the curve (AUC t = 6) and the mean residence time (MRT) were respectively 48.3 mghr/l and 5.2 hrs. The solution appears promising for further study in daily clinical practise.
Subject(s)
Acetaminophen/administration & dosage , Acetaminophen/pharmacokinetics , Analgesics, Non-Narcotic/administration & dosage , Preanesthetic Medication , Administration, Rectal , Area Under Curve , Child , Child, Preschool , Female , Hernia, Inguinal/blood , Hernia, Inguinal/surgery , Humans , MaleABSTRACT
The pharmacokinetics and tolerability of two dosage forms for rectal administration of paracetamol were compared. A fatty suppository was compared with a solution of 60 mg/ml paracetamol. Both dosage forms were given as 1000 mg doses to 10 healthy adult volunteers. The solution produced peak plasma concentrations significantly faster (t (max)) than did the suppository. The peak concentration (C(max)) and the area under the curve (AUC(6)) were also significantly greater. The pharmacokinetic characteristics of the solution were superior to those of the suppository. No difference in irritation score was identified and no discomfort was reported.
Subject(s)
Acetaminophen/pharmacokinetics , Administration, Rectal , Analgesics, Non-Narcotic/pharmacokinetics , Acetaminophen/administration & dosage , Acetaminophen/adverse effects , Acetaminophen/blood , Adult , Algorithms , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/adverse effects , Analgesics, Non-Narcotic/blood , Chromatography, High Pressure Liquid , Female , Humans , Male , Middle Aged , Reproducibility of Results , Software , Solutions , SuppositoriesABSTRACT
Pain prevention and analgesia in (adeno)tonsillectomy OBJECTIVE. To study the efficacy of three analgesia protocols in children subjected to (adeno)tonsillectomy. SETTING. Twenteborg District Hospital, Almelo, the Netherlands. PATIENTS AND METHODS. In 64 children with body weights ranging from 15 to 25 kg (mean 20.4 kg) subjected to (adeno) tonsillectomy according to the procedure most current in the Netherlands (according to Sluder with administration of a volatile anaesthetic without intubation in day treatment), three protocols for preventing and treating postoperative pain were applied, with the analgetics most current in the Netherlands. Permission from the Medical Ethical Committee and written informed consent from the parents were obtained. According to protocol I 240 mg paracetamol was given, according to protocol II, 500 mg paracetamol and according to protocol III, 500 mg paracetamol plus 10 mg codeine, in suppository form, every 4 hours always starting 60 minutes before operation. Initially, protocol I was carried out, subsequently randomization of protocols II and III. After a pilot study use of a control group was omitted for ethical reasons because of the severe pain in a placebo group. MEASUREMENTS. The efficacy of the analgesia was evaluated by means of pain assessments by the children themselves using the Oucher test, 1, 3 and 6 hours after operation. The statistical processing of the children's pain scores was performed primarily in a descriptive sense, with simultaneous comparison of the three groups using a single variance analysis for comparison of several groups. Multiple comparisons were carried out according to Ducans' multiple range test. The level of significance was put at p less than or equal to 0.05. RESULTS. One hour postoperatively there was no significant difference among the mean pain scores (0: no pain and 10: very bad pain) of the three groups, viz. 5.2 (SD 3.0), 4.7 (SD 2.9) and 4.7 (SD 2.3), respectively; three hours postoperatively there was a significant difference between the mean pain scores of group I (4.5; SD 2.4) and group II (2.7; SD 2.4) but not between group I and group III (3.3; SD 1.5); six hours postoperatively there was a significant difference between the mean pain scores of group I (4.1; SD 2.1) on the one hand and of groups II (2.1; SD 1.5) and III (2.6; SD 1.6) on the other. CONCLUSION. The findings indicate existence of violent pain immediately after recovery from anaesthesia after (adeno)tonsillectomy as shown by the pain assessments by the children themselves one hour postoperatively, in spite of preventive administration of a high dose of a 'minor' analgetic according to each of the three protocols. Modification of the anaesthetic technique should be considered to effect adequate prevention or suppression of pain.
