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[Nalbuphine and piritramid in the postoperative phase in young children. 1. General condition]
W Büttner1, W Finke, M Schwanitz
1Klinik für Anaesthesiologie und Operative Intensivmedizin, Ruhr-Universität Bochum, Marienhospital Herne.
Insights
Piritramide and nalbuphine significantly reduced the need for supplementary analgesics in children post-surgery compared to placebo. These opioid analgesics improved postoperative comfort and reduced pain medication requirements in young patients.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Pain Management
Background:
- Postoperative pain management in children is crucial for recovery.
- Evaluating the efficacy of different analgesics in pediatric patients is essential.
- Opioid analgesics are commonly used for moderate to severe pain.
Purpose of the Study:
- To compare the efficacy of piritramide and nalbuphine versus placebo in managing postoperative comfort in children.
- To assess the need for supplemental analgesics and observe behavioral responses in pediatric patients after surgery.
Main Methods:
- A randomized, double-blind trial involving 54 children (ASA I-II, aged 1-4 years).
- Standardized anesthesia (halothane) and premedication (midazolam, ketamine, atropine).
- Postoperative administration of piritramide, nalbuphine, or placebo, with behavioral assessments and analgesic requirement monitoring for 24 hours.
Main Results:
- The placebo group required significantly more midazolam during the first hour post-operation (64.7%) compared to piritramide (5.9%) and nalbuphine (35%).
- Over 24 hours, the placebo group had a higher need for supplemental analgesics (29.4% in the first 7 hours) than piritramide (23.5%) and nalbuphine (20%).
- Piritramide and nalbuphine demonstrated effectiveness in reducing overall analgesic requirements.
Conclusions:
- Both piritramide and nalbuphine are effective in improving postoperative comfort in children compared to placebo.
- These analgesics can reduce the need for additional pain medication in the early postoperative period.
- Further research may explore optimal dosing and long-term effects.
Abstract:
The influence of piritramide and nalbuphine versus placebo on the postoperative comfort of 54 children of ASA-group I and II in the age between 1 and 4 years was tested in a randomized double blind trial using the comfort/discomfort scale according to Büttner et al. METHODS. Operations, premedication and anesthesia were standardized. The patients were premedicated with midazolam 0.5 mg/kg rectally and a subsequent i.m. injection of ketamine 2.0 mg/kg with atropine 0.01 mg/kg. Anesthesia was induced and maintained by inhalation of oxygen/nitrous oxide and halothane (FiO2 = 0.3). All children were intubated and ventilation was controlled during the operation. After the operation, while in steady-state anesthesia with 0.5 vol% halothane and during spontaneous respiration the children received either piritramide (n = 17) or nalbuphine (n = 20) at a dose of 0.1 mg/kg, or placebo (n = 17) i.v. Respiratory and circulatory parameters were recorded for 15 min before the end of anesthesia. At 5 min after halothane had been discontinued the first measurement of the children's behavior was started, with 4 subsequent measurements at fixed time intervals of 15 min. The measuring system included the following 6 scaled items: wake-up reaction, methodical defense against stimuli, crying, facial expression, posture of the torso, posture of the legs. In addition, the waking state was scored at the same time intervals as awake, arousable, or not arousable. During the 1-h observation period all children who seemed to feel uncomfortable received midazolam i.v. at a maximal dose of 2 mg. Up to 24 h the required supplemental analgesics were noted, as were episodes of psychomotor agitation and vomiting. Written consent was obtained from the ethical committee and the children's parents. The results were tested in a 2-factorial analysis of variance (treatment factor: drugs; within-subject factor; repeated measurements). RESULTS. The 3 groups were considered to be comparable in terms of age, body weight, kind and duration of operation and circulatory values. The use of supplementary analgesics showed a significant effect in the treatment factor and in the within-subject factor: during the 1-h observation period the placebo group received midazolam significantly more often (64.7%) than the piritramide group (5.9%) or the nalbuphine group (35%). During the following 7 h 29.4% of the children of the placebo group required supplementary analgesics (piritramide: 23.5%; nalbuphine: 20%). Subsequently up to the 24th postoperative hour there was no need for any analgesic in the placebo group, whereas 11.8% of the piritramide group and 15% of the nalbuphine group required analgesics.(ABSTRACT TRUNCATED AT 400 WORDS)