Rectal Paracetamol Research Articles

Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery

Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery.ObjectivesThe objectives of this study were designed to detect the effects of addition of dexmedetomidine to bupivacaine on the quality of blind fascia iliaca compartment block and its possible side effects in children undergoing fracture femur surgery.MethodsThis study was conducted on 28 children (2–6 years of age), scheduled for fracture femur surgery. Children were randomly allocated to receive either 0.25% bupivacaine 1 ml kg−1 (B group), or 0.25% bupivacaine 1 ml kg−1 with dexmedetomidine 2 μg kg−1 (BD group). Anesthesia was maintained with sevoflurane 1–1.5 minimum alveolar concentration. Intraoperative sevoflurane concentration, hemodynamic, postoperative emergence delirium, sedation scores and pain scores were recorded. Duration of surgery and emergence time were recorded. Postoperative complications such as (nausea and vomiting, respiratory depression, purities, hypotension and bradycardia) were reported.ResultsCompared to the group B, patients received bupivacaine–dexmedetomidine for fascia iliaca compartment block had lower intraoperative sevoflurane concentration, higher sedation score, longer duration of postoperative analgesia, less use of rectal paracetamol for the first 24 h postoperatively and less number with postoperative agitation. No patients developed postoperative respiratory depression, purities, hypotension or bradycardia.ConclusionThe present study concluded that the combined use of bupivacaine–dexmedetomidine for fascia iliaca compartment block in children provided significant reduction of end-tidal sevoflurane concentration, remarkable hemodynamic stability, significant postoperative analgesia with lower postoperative analgesics requirements without any undesirable complications.

Effect of Rectal Paracetamol on BIS Guided Intraoperative Sedation and Postoperative Pain in Infertile Women Undergoing IVF Treatment, A Randomized Clinical Trial

Background: In vitro fertilization requires the harvesting of mature oocyte from the ovaries of infertile women under direct sonography, a process for which some form of anesthesia and analgesia is still required. Objectives: Evaluation the effect of rectal paracetamol on intraoperative sedation using bispectral index monitoring and postoperative pain using numeric rating scale in these group of patients. Pregnancy and implantation rates were also recorded. Material/patients and methods: Eighty ASA classes I or II women who were scheduled for oocyte retrieval were allocated into two equal groups and received rectal paracetmol or placebo one hour before surgery according to the allocations. Patients anesthetized with fentanyl and propofol and anesthesia was maintained with propofol infusion to achieve Bispectral Index value between45-65. Demographic data, Intraoperative propofol and fentanyl consumption, postoperative pain score and pregnancy and implantation rate were also recorded and compared between the two groups. Results: Demographic data were not statistically different between the study groups. Intraoperative propofol consumption was 67.4 ± 38.1 μg/kg/min in paracetamol and 87.0 ± 47.9 μg/kg/min in placebo group (P=0.04). No patient required additional fentanyl during the operation (P=0.06).Thirty two patients in paracetamol group and fourteen patients in placebo group had numeric rating scale ≤ 3 that was statistically significant (P<0.001). There was no difference in pregnancy and implantation rate between the study groups. Conclusion: preoperative rectal paracetamol reduced propofol consumption and postoperative pain in infertile women undergoing oocyte retrieval for invitro fertilization treatment. Pregnancy and implantation rates did not affected in this group of patients.

Anaesthesia and orphan disease

Anaesthesia and orphan disease

Rectal Paracetamol in Newborn Infants after Assisted Vaginal Delivery May Increase Pain Response

To assess the efficacy of paracetamol (acetaminophen) for neonatal pain relief. Randomized, double-blind placebo-controlled trial in 3 Swiss university hospitals. Term and near-term infants (n = 123) delivered by forceps or vacuum were randomized to receive 2 suppositories with paracetamol (60/80/100 mg in infants <3000 g/3000-4000 g/>4000 g birth weight) or placebo at 2 and 8 hours of life. Pain and discomfort during the first 24 hours was assessed by the échelle de douleur et d'inconfort du nouveau né [neonatal pain and discomfort scale] score. The response to the subsequent heel prick for metabolic screening at days 2-3 of life was investigated by the Bernese Pain Scale for Neonates (BPSN). The échelle de douleur et d'inconfort du nouveau né [neonatal pain and discomfort scale] pain scale ratings after assisted vaginal delivery were low and declined within 4 hours of life (P < .01) irrespective of paracetamol administration. At 2-3 days of life, BPSN scores after heel prick were significantly higher in infants who had received paracetamol, compared with controls, both when BPSN were scored by nurses at the bedside (median [IQR] 4 [2-7] vs 2 [0-5], P = .017) or off-site from videos (4 [2-8] vs 2 [1-7], P = .04). Thirty-five of 62 (57%) infants treated with paracetamol cried after heel prick, compared with 25 of 61 (41%) controls (P = .086). Infants born by assisted vaginal delivery have low pain scores in the immediate period after birth. Paracetamol given to newborns soon after birth may aggravate a subsequent stress response.

A03 Preemptive Analgesia with Paracetamol in Pediatric Neurosurgical Patients

Objective: to investigate the effectivness of preemptive analgesia with rectal paracetamol in children undergone neurosurgical interventions. Methods: with informed consent from parents we enrolled 16 children under 1 year underwent ventriculo-peritoneostomy. Monitoring included pulse oximetry, HR, ECG, NIBP, ETcapnography (Nihon Kohden, Siemens KION). Premedication: oral midazolam (0,08 mg/kg); total intravenous anesthesia: fentanyl (3, 5 mcg/kg/h), propofol (2, 5 mcg/kg/h); neuromuscular block: pipecuronium (0,1 mg/kg). Patients received preemptive analgesia with rectal paracetamol before incision (10 mg/kg). In postoperative period all the patients had been receiving rectal paracetamol (10 mg/kg) every 8 hours for two days. Blood samples were taken before anesthesia induction, during the operation and the next morning. We investigated prolactine, cortisol levels (IMMULITE). Also we assessed patient's pain with biobehavioral scales (NIPS, CHIPPS, CRIES). Results: before operation there were age-related normal hormone levels. We observed intraoperative increase of prolactine concentration. On the 1st postoperative day prolactine concentration decreased significantly comparing to intraoperative levels. Levels of cortisol during anesthesia and on the first postoperative day also decreased comparing to preoperative levels. There was a statistically significant difference (P < 0,05) between preoperative and postoperative levels of stress hormones. Biobehavioral scales in postoperative period showed 0–2 grades in all patients that indicated pain absence. Conclusion: decreasing of stress-hormones levels demonstrated that the preemptive analgesia with rectal paracetamol provides physiologically appropriate level of postoperative analgesia after neurosergical operations in children.

Pre-emptive Analgesia for Postoperative Pain Relief in Children – Role of Paracetamol

This prospective clinical study was carried out in the Dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka, during the period of May 2003 to July 2003. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain of pain and to produce smooth recovery after surgery by decreasing immediate postoperative pain in children by a simple, safe acceptable drug. The children scheduled for tonsillectomy under general anaesthesia were recruited in this study. The analgesic efficiency of rectal paracetamol in two doses, 25 mg/kg bodywt.(Gr-P25) and 50 mg/kg. bodywt. (Gr-P50) were compared with Diclofenac Sodium suppository 1mg/ kg body weight (Gr-D) given half an hour before induction of anaesthesia. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale). Heart rate and blood pressure were stable in Gr-P50 and Gr-D. Time of first demand of analgesic was delayed in Gr-P50 and Gr-D. Total paracetamol consumption in 24 hours was less in Gr-P50(181±14.25) and Gr-D (212±25) than Gr-P25(318± 26.39). Total duration of analgesia in Gr- P50 (657±9.94) mins. and in Gr- D(502±10.63) mins. and in Gr-P25(288±23.17) mins. Pre-emptive high dose rectal paracetamol appears to be more effective than diclofenac sodium suppository for postoperative analgesia in children undergoing tonsillectomy. Journal of BSA, Vol. 18, No. 1 &amp; 2, 2005 p.9-16

An unusual complication of an attempt to open the airway in a choking child

The use of a blind finger sweep to clear the upper airway can cause subsequent problems when used in paediatric practice. This case report adds support to recommendations that this procedure should not be used, while simultaneously describing a complication the authors have not come across in the published literature.

Oxycodone as a Component of Multimodal Analgesia Post‐Caesarean Section in Australia and New Zealand

ABSTRACTBackgroundThere is a perception that oral oxycodone is becoming a popular choice for post‐caesarean section analgesia. There are a lack of published data quantifying the use of oxycodone and other drugs for post‐caesarean section analgesia in Australasian practice.AimTo determine the use of oxycodone and other drugs for multimodal analgesia post‐caesarean section and to evaluate the compatibility of these drugs with breastfeeding.MethodFellows of the Australian and New Zealand College of Anaesthetists from 41 Australian and New Zealand obstetric units were invited to participate in an online survey on analgesic preference (drug, route of administration, dosing schedule) post‐caesarean section and whether breastfeeding considerations influenced their choice of analgesics.Results25 participants (response rate 61%) completed the survey. All of the responding obstetric units used multimodal analgesic protocols, which included oral and rectal paracetamol and non‐steroidal anti‐inflammatory drugs. Survey responses indicated that 50% of women in metropolitan hospitals and 95% of women in rural and regional hospitals would receive oral or rectal oxycodone post‐caesarean section. Approximately, 15% of women would be asked about their intention to breastfeed. 6% of anaesthetists would modify their choice of analgesic if the patient was breastfeeding.ConclusionThe obstetric units preferred oral and rectal analgesics over parenteral opioids and non‐steroidal anti‐inflammatory drugs. There was a high use of oxycodone for post‐caesarean section analgesia. The analgesics chosen were largely compatible with breastfeeding.

Analgesic and sedative effects of multimodal analgesia in stage of emergence after general anesthesia for cleft lip and/or palate prosthesis

To investigate the effects of multimodal analgesia on analgesia and sedation during emergence of general anesthesia for cleft lip and/or palate surgery pediatric patients. Fifty-four pediatric patients with ASA I and II cleft lip and/or palate, aged 2-7, undergoing prosthesis were randomly allocated into 2 groups: control group (Group C, n=28) inhaling nitrous oxide/oxygen (50%:50%) and sevoflurane(5%) for general anesthesia, and multimodal group (Group M, n=26), injected intravenously with fentanyl and atracurium in addition to inhalation of nitrous oxide/oxygen (50%:50%) and sevoflurane (5%). Ventilation was controlled with PCV modal to maintain end-tidal CO2 to 35-45 mmHg. Local anesthesia at the surgical site was facilitated by the surgeon before the beginning of surgery. After intubation, rectal paracetamol was used for Group M (120 mg for 2-4 year-olds and 325 mg for 5-7 year-olds) and fentanyl 0.5 microg/kg was injected for postoperative analgesia 10 min before the end of surgery. An observer who was blinded to the protocol recorded the time from the discontinuation of sevoflurane and nitrous oxide to tracheal extubation, accessed the sedation and pain scale, recorded the time ready for discharge from post-anesthesia care unit (PACU) and the incidence of adverse effects. The time ready for discharge from PACU of Group M was (25+/-4) min, significantly shorter than that of Group C [(32+/-3) min, t=7.426, P<0.01]. The analgesia satisfaction rate of Group M was 69.2% (18/26), significantly higher than that of Group C [25.0%, 7/28, P<0.05]. The severe pain rate of Group M was 7.7%, significantly lower than that of Group C (35.7%, F=5.333, P=0.021). The agitation rate of Group M was 11.5%, significantly lower than that of Group C (39.3%, F=4.571, P=0.033). Multimodal analgesic regimen of infiltration of local anesthetic at surgical site and rectal paracetamol and intravenous fentanyl provides sufficient analgesia, minimizes the incidence of agitation after general anesthesia in cleft lip and/or palate surgery for children, increases the speed of referring patients in PACU, and ensures the safety of the postanaesthetic patients.

A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

To establish whether caudal with ketamine or penile block provide superior postoperative analgesia for paediatric circumcision. This was a single centre, prospective, randomized, controlled, double-blind trial. Forty males (aged between 18 months and 16 yr) were randomized to receive either a penile block using 0.25 mL kg(-1) 0.5% bupivacaine (Group P), or a caudal block using 0.5 mL kg(-1) 0.25% bupivacaine with 0.5 mg kg(-1) ketamine (Group C). All of them were given a standard anaesthetic and rectal paracetamol 40 mg kg(-1) and diclofenac 1-1.5 mg kg(-1). Postoperative pain scores were assessed in recovery and the time to first analgesia, micturition and walking were recorded. There were no failures in either group. The time to first analgesia was longer in Group C (C median = 459 min, interquartile range 374-553 min; P median = 374 min, interquartile range 224-507 min; P < 0.05). There was a delay in time to walking in Group C (C median = 162 min, interquartile range 119-208 min; P median = 120 min, interquartile range 92-132 min; P < 0.05). There was no difference between the groups in time to waking or micturition, or the incidence of vomiting, abnormal behaviour or bleeding. Caudal bupivacaine with ketamine and penile block both provide effective postoperative analgesia for circumcision when given with non-steroidal anti-inflammatory drugs. This study shows that caudal bupivacaine with ketamine provides a longer duration of analgesia than penile block, but also causes delay in walking.

Pharmacokinetics and analgesic effects of intravenous propacetamol vs rectal paracetamol in children after major craniofacial surgery

The pharmacokinetics and analgesic effects of intravenous and rectal paracetamol were compared in nonventilated infants after craniofacial surgery in a double-blind placebo controlled study. During surgery all infants (6 months-2 years) received a rectal loading dose of 40 mg.kg(-1) paracetamol 2 h before anticipated extubation. On admittance to the pediatric surgical ICU, the children were randomized to receive either a 15 min intravenous infusion of 40 mg.kg(-1) propacetamol, a prodrug of paracetamol, or 20 mg.kg(-1) paracetamol rectally every 6 h. A population pharmacokinetic analysis of the paracetamol plasma concentration time-profiles was undertaken using nonlinear mixed effects models. The visual analogue scale (VAS) (score 0-10 cm) and COMFORT Behavior scale (score 6-30) were used to monitor analgesia in the 24-h period following surgery. Twelve infants received intravenous propacetamol and 14 paracetamol suppositories. Paracetamol pharmacokinetics were described according to a two-compartmental model with linear disposition. Pharmacokinetic parameters were standardized to a 70 kg person using allometric '1/4 power' models. Parameter estimates were: absorption half-life from the rectum 4.6 h, propacetamol hydrolysis half-life 0.028 h, clearance 12 l.h(-1).70 kg(-1), intercompartmental clearance 116 l.h(-1).70 kg(-1), central and peripheral volume of distribution 7.9 and 44 l.70 kg(-1), respectively. During the 24-h study period 22 infants exhibited VAS scores <4 cm, which was considered a cutoff point. On single occasions four patients, two in each group, exhibited a VAS score >/=4 cm. Nine patients in the rectal treatment group and three patients in the intravenous treatment group received midazolam for COMFORT-B scores exceeding 17 (P < 0.05). Intravenous propacetamol proved to be more effective than rectal paracetamol in infants after craniofacial surgery. Midazolam was more frequently administered to patients receiving paracetamol suppositories, indicating that these children experienced more distress, possibly caused by pain.

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Both rectal diclofenac and paracetamol are commonly used to treat acute postoperative pain in children but combining them to improve the quality of analgesia is controversial. This study aimed to detect whether the pre-operative combined administration of rectal diclofenac and paracetamol is superior to either drug alone. One hundred and eight patients were randomly assigned to receive either rectal diclofenac 1 mg.kg(-1) or paracetamol 40 mg.kg(-1) or their combination 1 h prior to surgery. In the first 24 h postoperatively, pain was assessed using the Wong and Baker Pain Scale. If the patients experienced a pain score of 2 or more, morphine was given. The total dose of morphine and number of doses required were recorded. Children who received the rectal diclofenac-paracetamol combination experienced a lower pain scale and a decreased need for morphine compared with children receiving each drug alone.

Lamula's story

A 36-year-old gravida 6 para 5 +0 was brought to the hospital with a ruptured uterus. Her name was Lamula and this is her story. Lamula lives many miles from the district hospital and regional referral hospital. At term, she started labour and was taken to the Traditional Birth Attendant (TBA) who attended to her for 12 h until the labour pains became severe. During the course, the TBA gave her local herb mixtures to drink, with no result. Lamula's husband decided to take her to the health centre that is 11 km away. On his bicycle, he rode amidst her screaming, and after 4 h they were at the health centre. The midwife examined her and diagnosed obstructed labour. She immediately referred her to the main hospital that is 65 km from the health centre. The health centre ambulance assisted in transportation and in 1.5 h, Lamula was in the hospital. In the hospital, the doctor examined her and found out that Lamula had a ruptured uterus. He then recommended an emergency caesarean section. Unfortunately, there was no blood in their hospital, and Lamula had to be referred to the National Referral Hospital, which is 30 km away. Lamula reached the hospital at 1800 h. Her husband was not in her company because he had gone back home to prepare for hospital admission. Lamula was immediately admitted and put on intravenous fluids (0.9% saline). The doctor took a history and on examination he confirmed that Lamula had a ruptured uterus with severe haemorrhage and no fetal heart was heard. Emergency obstetric theatre was informed and the anaesthetic officer was summoned. She quickly went to the labour ward and started to resuscitate Lamula as she was in great danger. She found that she was severely anaemic with a thready pulse and her blood pressure was unrecordable. The officer classified Lamula as ASA IVE. She put up two large bore cannulae, gave a bolus of 2 l saline 0.9% and catheterised Lamula. There was no blood in the blood bank, but the anaesthetist insisted that Lamula's life could be saved. Lamula was then taken to theatre and placed onto the operating table. The starting blood pressure was unrecordable. Intravenous atropine was given; she was pre-oxygenated with 100% oxygen and anaesthesia induced by a rapid sequence induction with ketamine 50 mg followed by suxamethonium 25 mg. Anaesthesia was maintained with low dose ether and 100% oxygen. Intra-operative monitoring was done by precordial stethoscope and blood pressure was checked with an oscillotonometer every 5 min. At the end of the operation the blood pressure was still unrecordable. Awake extubation was done and rectal paracetamol was given. Lamula remained in the theatre recovery room under observation of the anaesthetist for 4 h, after which she was transferred to the postnatal ward with a blood pressure of 50/30 mmHg. The anaesthetist accompanied her to the ward, and gave both written and verbal instructions to the nurses. These included covering with blankets, giving warm intravenous fluids and keeping good records. Meanwhile, the urine in the urinary bag was at 100 ml. There was still no blood available. The next morning, the anaesthetist visited Lamula and found out that Lamula was doing well; she was alert and had a blood pressure of 80/60 mmHg and urine output of 500 ml. The anaesthetist then managed to secure 1 unit of whole blood and Lamula was transfused with that. On the ward, Lamula was prescribed intravenous antibiotics (ampicillin, gentamicin, and metronidazole). The anaesthetist tried to get the prescribed antibiotics that were not readily available in the hospital for her. After the first week, the husband of Lamula reached the hospital from the village, and that is when the anaesthetist withdrew from the burden of being the attendant. Had it not been for the good practices of the anaesthetist, Lamula would have died either in labour ward or the operating theatre or even on the ward postoperatively.

Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial

This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane. Sixty-eight ASA I-II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg-1, clonidine 2 microg kg-1, and clonidine 4 microg kg-1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg-1) and rectal paracetamol (30 mg kg-1). During the first postoperative hour, children were evaluated using a modified 'objective pain scale'. Only the 4 microg kg-1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 microg kg-1 group displayed agitation (25%) than in the midazolam group (60%) (P=0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups. In comparison with midazolam, clonidine 4 microg kg-1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.

Pharmacokinetics of rectal compared to intramuscular paracetamol in children undergoing minor surgery

<b>Objectives</b> : Although paracetamol is a widely accepted and safe analgesic, guidelines regarding its definite analgesic dose are lacking. This study was, therefore, undertaken to compare the pharmacokinetics of paracetamol when administered by two routes, viz, intramuscular and rectal, in children undergoing minor surgery. <br><b> Design</b> : Randomized, controlled, assessor-blind, comparative clinical trial. <br>Materials and Methods: Following Institutional Ethics Committee approval and valid consent, children undergoing minor surgery were randomized to receive paracetamol either intramuscularly or rectally. Blood samples were collected at fixed intervals for estimation of drug levels. <br><b> Results</b> : Fifty children (43 boys, 7 girls; ages 3 to 12 years; weight 10 to 40 kg) were enrolled in the study. 26 patients were randomized to receive paracetamol intramuscularly (mean dose 14.8 ± 0.9 mg/kg) and 24 to receive the paracetamol as a rectal suppository (mean dose 29.5 ± 1.4 mg/kg). Complete pharmacokinetic analysis was possible in only 29 patients, as the blood samples of the others were either not received or were inadequate for analysis. The mean maximum plasma concentration (C_max ) with rectal paracetamol (n = 13) was 6.04 ± 2.21 mg/ml with a T_max of 2.5 ± 0.89 h, while with intramuscular paracetamol (n = 16), the C_max was 10.34 ± 7.09 mg/ml and the T_max 1.47 ± 0.64 h. The area under the concentration-time curve (AUC_0-12 ) was 42.26 ± 22.29 µg.h/ml and 43.60 ± 26.45 µg.hr/ml for rectal and intramuscular paracetamol, respectively. Patients in the intramuscular group needed rescue medication earlier as compared to those in the rectal group (P < 0.05). <br><b> Conclusion</b> : Although the drug levels achieved with rectal paracetamol were less than that achieved with intramuscular administration, it was higher than the lower limit for analgesic effect (3-5 µg/ml). Patients who received paracetamol intramuscularly needed rescue medication earlier compared to those receiving paracetamol rectally, indicating a more prolonged duration of action with rectally administered paracetamol. Hence, rectal paracetamol can be used as a safe, effective, and more acceptable analgesic alternative in children.

When to add supplemental rectal paracetamol for postoperative analgesia with caudal bupivacaine in children? A prospective, double-blind, randomized study

The aim of this study was to investigate whether a supplemental dose of rectal paracetamol at the third or fourth hour would enhance the quality of analgesia provided by caudal epidural blockade in children. Two hundred and two ASA I patients aged 1-12 years undergoing inguinal surgery were randomized into three groups in the postanesthesia care unit by drawing lots. Patients in the control group did not receive any analgesic until they had a pain score of 5 or higher, patients in the group P3 received rectal paracetamol (20-25 mg x kg(-1)) at the third hour, and patients in the group P4 received the same dose of rectal paracetamol at the fourth hour after caudal epidural injection. Pain was assessed by VAS (Visual Analog Scale) and supplementary rescue analgesic need was recorded. There was no difference between the demographic data or the duration and variety of surgery among the groups. A significantly lower number of patients required rescue analgesia at the sixth postoperative hour in group P3 and also lower pain scores were again obtained in group P3 at the sixth and eighth postoperative hours. Supplemental rectal paracetamol at the third hour of caudal blockade enhances the quality of postoperative analgesia better than its addition at the fourth hour in children undergoing inguinal surgery.

Variation in anaesthesia for the laser treatment of retinopathy of prematurity—a survey of ophthalmologists in the UK

Laser treatment for retinopathy of prematurity (ROP) may be associated with systemic stress for the infant. No national consensus on the optimum method of anaesthesia for the treatment of ROP currently exists. This study ascertains the anaesthetic practices employed for the treatment of ROP by ophthalmologists in the United Kingdom (UK), and also their attitudes towards these practices. A postal questionnaire was sent to 46 consultant ophthalmologists identified as performing treatment for ROP in the UK. The consultants were asked to estimate the annual number of babies with ROP that they treated with laser, what methods of anaesthesia they employed, for comments regarding the arrangements for, and types of anaesthesia employed and whether they believed that the neonatal stress response to laser treatment was associated with a significant risk of systemic complications. In all, 35 (76%) questionnaires were returned. A total of 30 (86%) respondents reported performing laser treatment for ROP. Of these, 15 (50%) used general anaesthesia for all cases and 11 (37%) intravenous sedation combined with topical anaesthesia for all cases. Oral sedation combined with topical anaesthesia, rectal chloral hydrate and paracetamol combined with topical anaesthesia, intravenous ketamine combined with topical anaesthesia, and subtenon's local anesthesia were used by one (3%) respondent each. There were no ophthalmologists using subconjunctival or topical anaesthetic alone or treating without anaesthesia. This survey reveals considerable variation in practice among UK ophthalmologists regarding the anaesthetic methods employed in the treatment of ROP, and their beliefs regarding the systemic stress associated with treatment.

Prospective randomised controlled trial comparing rectal versus oral paracetamol and diclofenac in children following appendicectomy

Summary The analgesic efficacy and pharmakokinetics of paracetamol and diclofenac are similar. We have studied the pain reported by patients and the acceptability of the modes of analgesia of 31 paediatric patients undergoing appendicectomy. No significant difference in pain scores or need for rescue analgesia was found. The oral route was preferred.

Evaluation of adding preoperative or postoperative rectal paracetamol to caudal bupivacaine for postoperative analgesia in children

Our aim was to investigate whether effects of caudal analgesia could be extended by preoperative or postoperative rectal paracetamol administration in children undergoing surgical repair of hypospadias. The group consisted of 60 ASA I boys, aged 3-12 years, who were operated for surgical repair of hypospadias. The patients were randomized into three groups: patients in group I received rectal paracetamol (20-25 mg x kg(-1)) just before the operation. Group II received only caudal bupivacaine. Group III patients received rectal paracetamol (20-25 mg x kg(-1)) at the end of the operation. Pain was assessed by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and the degree of sedation was evaluated. During the first 24 h, time to the patients' first analgesic requirement and the number of supplementary analgesics needed were recorded. There was no difference between the demographic and haemodynamic data of the three groups. In addition, the duration of surgery and anaesthesia, pain scores and sedation scores of the groups were not significantly different. Addition of preoperative or postoperative rectal paracetamol in the doses used did not show an effect on the duration and intensity of postoperative analgesia obtained by caudal bupivacaine.

Randomized, double‐blind, placebo‐controlled study of the effect of rectal paracetamol on morphine consumption after abdominal hysterectomy

Paracetamol is widely used for postoperative analgesia. The effect is well documented in minor and moderate extensive surgery, but the effect of paracetamol as an adjunct to opioids in major abdominal surgery is less examined. Seventy-eight patients scheduled for elective, benign, and abdominal hysterectomy were included in a prospective, randomized, double-blind, parallel group, placebo-controlled study to evaluate the effect of rectal paracetamol in conjunction with intravenous patient-controlled analgesia (PCA) morphine. Paracetamol 1000 mg or placebo suppositories were given four times daily during the 60-h study period. I.V. morphine was administered via a PCA pump, limited to maximum of 12 mg h-1. Morphine consumption, pain and morphine-related adverse effects were recorded. A single-point analysis was comprised of serum concentrations of paracetamol and morphine. Sixty patients were evaluated: 30 in each group. A 16.6% reduction in overall-accumulated morphine consumption in the treatment group (99.6 vs. 83.3 mg) was observed (NS, P = 0.06). Mean paracetamol serum concentration was 0.03 mmol l-1 (range: 0.01-0.06 mmol l-1). None of the patients had a paracetamol concentration within the therapeutic range for antipyretic efficacy. Patients with a higher paracetamol concentration had a lower concomitant morphine (P = 0.025) and morphine-6-glucuronide (P = 0.014) concentration 2 h after paracetamol administration. A dosage of rectal paracetamol 1000 mg four times daily is too low, as all displayed a suboptimal serum paracetamol concentration. To study the effect of rectal paracetamol after major surgery we have to increase the dose, as higher serum concentrations of paracetamol may cause lower serum concentrations of morphine.