Related Experiment Videos
Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen
P Gaudreault1, J Guay, O Nicol
1Department of Pediatrics, Hospital Sainte-Justine, Montreal, Quebec.
Insights
Rectal acetaminophen in children undergoing tonsillectomy showed incomplete absorption and did not effectively manage postoperative pain compared to meperidine. This route is not recommended for immediate pain relief in this pediatric population.
Area of Science:
- Pediatric Anesthesiology
- Pharmacokinetics
- Pain Management
Background:
- Acetaminophen is a common oral analgesic for children.
- Rectal administration is used when oral intake is not possible (e.g., vomiting, unconsciousness).
- Rectal absorption of medications, including acetaminophen suppositories, can be erratic.
Purpose of the Study:
- To measure the absorption of an aqueous acetaminophen solution administered rectally in children.
- To evaluate the postoperative analgesic efficacy of rectal acetaminophen compared to meperidine in pediatric patients undergoing adenoidectomy and/or tonsillectomy.
- To assess the impact of rectal acetaminophen on immediate postoperative pain.
Main Methods:
- A study involving children aged 1 to 8 years undergoing adenoidectomy and/or tonsillectomy.
- Twenty children received 20 mg/kg of rectal acetaminophen at anesthesia induction.
- Twenty children received 1 mg/kg of intramuscular meperidine.
- Pain assessment and need for additional analgesia were recorded.
Main Results:
- Rectal acetaminophen absorption was incomplete, with delayed peak serum concentrations (70.8 mumol/L).
- No statistical difference in pain management was observed between the acetaminophen and meperidine groups.
- A significant number of patients (32) required additional meperidine in the recovery room, irrespective of the initial treatment.
Conclusions:
- Rectal administration of acetaminophen in children results in incomplete and delayed absorption.
- Rectal acetaminophen did not prevent immediate postoperative pain in children undergoing adenoidectomy/tonsillectomy.
- The study suggests that rectal acetaminophen is not an effective method for managing immediate postoperative pain in this pediatric surgical context.
Abstract:
Acetaminophen is frequently administered orally to children for its analgesic properties, although its potency has never been clearly evaluated in this population. In certain situations (patients vomiting or unconscious), acetaminophen has to be given rectally. However, the rectal absorption of suppositories is frequently erratic. We undertook this study first, to measure the absorption of an aqueous solution of acetaminophen administered rectally. Secondly, we evaluated acetaminophen's postoperative analgesic effects in children aged 1 to 8 years old undergoing adenoidectomy and/or tonsillectomy and compared its efficacy to meperidine. Twenty children received 20 mg.kg-1 of acetaminophen at the time of induction of anaesthesia while 20 others received 1 mg.kg-1 of meperidine intramuscularly. Thirty-two patients required meperidine in the Recovery Room. There was no statistical difference between the patients who received acetaminophen (18), and those who received meperidine (14). The absorption of acetaminophen was incomplete (peak serum concentration: 70.8 mumol.L-1) and delayed. We conclude that the rectal administration of acetaminophen at the induction of anesthesia results in incomplete and delayed absorption and does not prevent the occurrence of immediate postoperative pain in children undergoing adeno-tonsillectomy.