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Efficacy of rectal ibuprofen in controlling postoperative pain in children
E L Maunuksela1, P Ryhänen, L Janhunen
1Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Insights
Ibuprofen effectively reduced postoperative pain and opioid requirements in children undergoing surgery. This scheduled administration, starting before surgery, improved pain scores and patient-reported outcomes.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Pain Management
Background:
- Postoperative pain management in children is crucial for recovery.
- Non-opioid analgesics are sought to minimize opioid-related side effects.
Purpose of the Study:
- To evaluate the efficacy of scheduled rectal ibuprofen for postoperative pain in children aged 4-12 years.
- To compare pain scores, vital signs, and opioid requirements between ibuprofen and placebo groups.
Main Methods:
- Double-blind, placebo-controlled study involving 128 pediatric patients undergoing elective surgery.
- Rectal ibuprofen (40 mg.kg-1.day-1) or placebo administered for up to three days postoperatively.
- Pain, sedation, heart rate, blood pressure, and respiratory rate were monitored; morphine was administered as needed.
Main Results:
- Children receiving ibuprofen showed lower heart rates and pain scores in the recovery room.
- Ibuprofen group required significantly less additional morphine postoperatively compared to placebo.
- Patient-reported analgesic efficacy was higher in the ibuprofen group on the day of operation.
Conclusions:
- Scheduled preoperative ibuprofen is an effective strategy for managing pediatric postoperative pain.
- Ibuprofen reduces the need for opioid analgesics, improving patient comfort and potentially reducing side effects.
- Further research may explore optimal dosing and duration for different surgical types.
Abstract:
The efficacy of ibuprofen with scheduled administration, starting preoperatively, for postoperative pain was studied in 128 boys and girls, 4 to 12 yr old, having elective surgery. In a double blind placebo-controlled study, rectal ibuprofen (40 mg.kg-1.day-1 in divided doses) or placebo was given for up to three days. For two hours after surgery heart rate, blood pressure and respiratory rate were recorded every 15 min together with sedation scores and pain scores, as assessed by an observer and the patient. Morphine was given to all children, 0.1 mg.kg-1 iv or 0.15 mg.kg-1 im according to clinical needs. Every morning on the ward the patients were interviewed about the efficacy of the analgesic treatment. All unwanted effects were registered. In the recovery room the heart rate was lower (P less than 0.05) and the patient's pain scores were less (P less than 0.05) in the ibuprofen group. After orthopaedic operations children needed more opioid than after ophthalmic or general surgical procedures (P less than 0.001). However, after all operations the need for additional morphine was less in the recovery room (P less than 0.05), during the day of operation (P less than 0.01) and during the three-day study period (P less than 0.01) in children receiving ibuprofen. On the day of operation the analgesic therapy was considered to be good or very good by 44/53 and 32/49 of the children in ibuprofen and placebo groups, respectively (P less than 0.05). Later, their assessments did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)