Key result
Rectal acetaminophen yielded a higher mean area under the concentration-time curve (171.2 mg/h/L) than oral acetaminophen (111.9 mg/h/L) for postoperative pain in toddlers.
Why the study?
Plasma concentrations of acetaminophen in newborns and infants who have undergone major surgery had not yet been determined in the research literature.
Does oral acetaminophen compared to rectal acetaminophen improve plasma concentrations and pain scores in toddlers undergoing craniofacial surgery?
RCT (n=40)
No
Does oral acetaminophen compared to rectal acetaminophen improve plasma concentrations and pain scores in toddlers undergoing craniofacial surgery?
Rectal administration of acetaminophen is more effective than oral administration for achieving target plasma concentrations in toddlers following craniofacial surgery, largely due to vomiting associated with oral intake.
Answers are grounded in this paper and cite their sources.
Rectal acetaminophen may yield higher exposure than oral in postoperative toddlers; leaves open effects on pain scores and need for RCTs.
Background and objectives: In newborns and infants who have just undergone major surgery, the plasma concentrations of the painkiller acetaminophen (INN, paracetamol) have not yet been determined in the research literature. As a result, we conducted a study in the intensive care unit of our hospital. Study Methods: During elective craniofacial correction, 40 toddlers with a mean (standard deviation) age of 10.3 (2.3) months received 20 mg/kg of acetaminophen orally (n = 20) or rectally (n = 20) every 6 hours following a rectal loading dose of 40 mg/kg. Pain assessments were made every three hours, and blood samples were taken an hour before and two hours after the administration of acetaminophen maintenance dosages. Results and discussion: The mean area under the concentration-time curve (AUC) for patients receiving rectal acetaminophen was 171.2 mg/h/L, while the mean AUC for patients receiving oral acetaminophen was 111.9 mg/h/L. Patients receiving oral acetaminophen reported greater pain scores. However, acetaminophen plasma concentrations and pain scores did not differ across the groups once the patients who vomited were removed from the oral acetaminophen group. Acetaminophen plasma concentrations and pain ratings did not correlate. Despite the fact that 9 out of 40 patients (or 22.5%) did not achieve the desired analgesic acetaminophen plasma concentrations of 10 to 20 mg/L, 7.5% of the pain scores on the visual analogue scale were higher than the 4 cm cutoff criterion. Conclusion: These are the first results demonstrating that following major surgery in this age range, the analgesic acetaminophen plasma concentration does not always reach the 10 to 20 mg/L level. These results also demonstrate that the rectal route is the most effective approach to provide acetaminophen following craniofacial surgery once a rectal loading dosage of 40 mg/kg has been administered during surgery.
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Krishna et al. (2021) conducted an RCT in Postoperative pain following craniofacial surgery (n=40). Rectal acetaminophen vs. Oral acetaminophen (20 mg/kg every 6 hours) was evaluated on Mean area under the concentration-time curve (AUC). Rectal acetaminophen yielded a higher mean area under the concentration-time curve (171.2 mg/h/L) than oral acetaminophen (111.9 mg/h/L) for postoperative pain in toddlers.
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