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The analgesic efficacy of preoperative high dose (40 mg·kg –1 ) oral acetaminophen after bilateral myringotomy and tube insertion in children
Author(s) -
BOLTON PHILLIP,
BRIDGE HILARY S,
MONTGOMERY CAROLYNE J,
MERRICK PAMELA M
Publication year - 2002
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.2002.00743.x
Subject(s) - medicine , pacu , analgesic , acetaminophen , anesthesia , visual analogue scale , pain scale , dose , surgery
Background : The purpose of this study was to measure the plasma levels and analgesic effectiveness of a dose of 40 mg·kg –1 of preoperative oral acetaminophen. Methods : Thirty children aged 55 (17–72) months undergoing bilateral myringotomy and tube insertion (BMT) received acetaminophen 40 mg·kg –1 p.o. preoperatively. Plasma levels were measured, at 29 (10–51) min and at 60 min in the postanaesthesia care unit (PACU). Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), for all subjects and the Poker Chip Tool (PCT) a self‐report scale for subjects aged > 4 years, were used. After discharge, 24‐h analgesic efficacy was evaluated using an observer Visual Analogue Scale (VAS) score and further acetaminophen use was recorded. Results : Plasma concentrations were 259 (60–391) μmol·l –1 and 250 (135–450) μmol·l –1 , respectively. All 60 min plasma concentrations were ≥ 70 μmol·l –1 (ED 50 for adenotonsillectomy) and less than 800 μmol·l –1 (associated with toxicity). Twenty‐six subjects (87%) had adequate analgesia (CHEOPS ≤ 8). The PCT was only understood in the PACU by 13 of the 21 children > 4 years (62%). The median worst 24‐h observer VAS was 0.5 (0–5.5) (27 subjects). No further analgesic was required after discharge in 16/28 (57%). A higher plasma level was associated with fewer doses of acetaminophen after discharge ( r =–0.36, P =0.05). Conclusions : No relationship was evident between age, the 60 min plasma acetaminophen level and the CHEOPS carried out at the same time. Acetaminophen 40 mg·kg –1 p.o. results in 60 min plasma levels of 250 (135–450) μmol·l –1 . The in‐hospital analgesic efficacy was 87% (CHEOPS < 9, no further analgesics) and the 24‐h efficacy was 57% (need for further acetaminophen).