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Rectal indomethacin for analgesia after appendicectomy in children
C Sims1, C M Johnson, R Bergesio
1Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, W.A.
Insights
Rectal indomethacin significantly reduced morphine use in children undergoing appendicectomy. This non-steroidal anti-inflammatory drug provided comparable postoperative pain relief to placebo while decreasing opioid consumption.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Postoperative pain is a significant concern in pediatric appendicectomy.
- Opioid analgesics are commonly used but associated with side effects.
- Non-steroidal anti-inflammatory drugs (NSAIDs) offer an alternative or adjunct for pain management.
Purpose of the Study:
- To evaluate the efficacy of rectal indomethacin in reducing postoperative opioid requirements in children.
- To compare pain scores and side effects between indomethacin and placebo groups.
Main Methods:
- Prospective randomized controlled trial involving 30 children (aged 7+) undergoing open appendicectomy.
- Administration of rectal indomethacin (2 mg/kg) or placebo at surgery and 12, 24 hours postoperatively.
- Patient-controlled analgesia (PCA) with morphine for all participants.
Main Results:
- Children receiving indomethacin used 44% less morphine (0.51 mg/kg) compared to placebo (0.91 mg/kg) (P < 0.02).
- Visual analogue scale pain scores, sedation scores, and vomiting incidence were similar between groups.
- Rectal indomethacin demonstrated comparable postoperative analgesia to placebo.
Conclusions:
- Rectal indomethacin is effective in reducing postoperative morphine consumption in children after appendicectomy.
- Indomethacin provides adequate pain relief without increasing adverse effects.
- This NSAID represents a valuable option for multimodal analgesia in pediatric surgical patients.
Abstract:
A prospective randomised controlled trial comparing rectal indomethacin with placebo was performed in children. Thirty children aged seven years and over undergoing open appendicectomy were given suppositories of either indomethacin 2 mg/kg or placebo. Suppositories were given at the conclusion of surgery and again 12 and 24 hours later. All children were given morphine by a patient-controlled analgesia pump. After 36 hours, children given indomethacin had used 0.51 (SD 0.34) mg/kg, and children given placebo 0.91 (SD 0.46) mg/kg (P < 0.02). Pain scores measured with a visual analogue scale, sedation scores and the incidence of vomiting were similar in both groups. Children given indomethacin suppositories used 44% less morphine than children given placebo, and at the same time obtained similar postoperative analgesia.