Related Experiment Videos
Nonsteroidal anti-inflammatory drugs for postoperative pain: a focus on children
1Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. hannu.kokki@kuh.fi
Insights
Nonsteroidal anti-inflammatory drugs (NSAIDs) effectively manage mild to moderate pediatric postoperative pain. A proactive approach with appropriate formulations is key, but caution is advised for certain patient groups due to potential bleeding risks.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Pain Management
Background:
- Postoperative pain in children is common and significant, even after brief procedures.
- Effective pain management is crucial for pediatric surgical recovery.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are valuable for managing pain and inflammation after surgery.
Purpose of the Study:
- To review the efficacy and safety of NSAIDs for pediatric postoperative pain management.
- To discuss optimal strategies for using NSAIDs in children, including formulation and administration.
- To highlight contraindications and precautions for NSAID use in pediatric patients.
Main Methods:
- Review of pediatric studies on NSAID efficacy and safety.
- Analysis of different NSAID formulations and administration routes for children.
- Examination of potential adverse effects and contraindications of NSAIDs in pediatric populations.
Main Results:
- NSAIDs are effective for mild to moderate pain and can be combined with other analgesics for severe pain.
- A proactive, regular dosing schedule is more effective than treating established pain.
- Intravenous administration is preferred when feasible; oral formulations vary in suitability for children.
- Ibuprofen, diclofenac, ketoprofen, and ketorolac are commonly evaluated NSAIDs, with no major differences in analgesic action expected at appropriate doses.
- Potential increased bleeding risk, particularly with ketorolac, is a consideration, though severe adverse effects are rare.
Conclusions:
- NSAIDs are a cornerstone of pediatric postoperative pain management, particularly when used proactively.
- Careful consideration of drug formulation, administration route, and patient-specific factors is essential for safe and effective use.
- While generally safe, NSAIDs require caution in children with specific comorbidities, and awareness of potential adverse effects like bleeding is important.
Abstract:
Pain is a common symptom after surgery in children, and the need for effective pain management is obvious. For example, after myringotomy, despite the brief nature of the procedure, at least one-half of children have significant pain. After more extended surgery, such as tonsillectomy, almost all children have considerable pain longer than 7 days. Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful for postoperative pain management because surgery causes both pain and inflammation. Several pediatric studies indicate NSAIDs are effective analgesics in the management of mild and moderate pain. In the treatment of severe pain, NSAIDs should be given with acetaminophen (paracetamol) or opioids, and the use of an appropriate regional analgesic technique should be considered. NSAIDs are more effective in preventing pain than in the relief of established pain. Pain following surgery is best managed by providing medication on a regular basis, preventing the pain from recurring. This proactive approach should be implemented for any procedure where postoperative pain is the likely outcome. In children, the choice of formulation can be more important than the choice of drug. Intravenous administration is preferred for children with an intravenous line in place; thereafter mixtures and small tablets are feasible options. Children dislike suppositories, and intramuscular administration should not be used in nonsedated children. Ibuprofen, diclofenac, ketoprofen and ketorolac are the most extensively evaluated NSAIDs in children. Only a few trials have compared different NSAIDs, but no major differences in the analgesic action are expected when appropriate doses of each drug are used. Whether NSAIDs differ in the incidence and severity of adverse effects is open to discussion. Because NSAIDs prevent platelet aggregation they may increase bleeding. A few studies indicate that ketorolac may increase bleeding more so than other NSAIDs, but the evidence is conflicting. Severe adverse effects of NSAIDs in children are very rare, but it is important to know about adverse effects in order to recognize and treat them when they do occur. NSAIDs are contraindicated in patients in whom sensitivity reactions are precipitated by aspirin (acetylsalicylic acid) or other NSAIDs. They should be used with caution in children with liver dysfunction, impaired renal function, hypovolemia or hypotension, coagulation disorders, thrombocytopenia, or active bleeding from any cause. In contrast, it seems that most children with mild asthma may use NSAIDs.