Zeliha KORKMAZ DİŞLİ, Hülya GÜNDOĞDU, Nalan ÇELEBİ

The effect of intravenous paracetamol infusion on postoperative nausea-vomiting and pain following strabismus surgery in children- a randomised controlled trial

Strabismus surgery is associated with postoperative nausea-vomiting (PONV) and pain. In this prospective-randomized trial we aimed to investigate the effects of intraoperative paracetamol infusion on postoperative nausea-vomiting and pain following strabismus surgery in children. Following approval of ethical committee 50 pediatric patients aged between 3-12 physical status of ASA I-II (American Society of Anesthesiology) undergoing strabismus surgery are included in the study between 2012 and 2013 years. Patients were excluded from the study for these following reasons: known allergic history to paracetamol or other non-steroidal anti-inflammatory drugs (NSAID), morphine and other drugs used in the study; asthma; liver or kidney dysfunction and bleeding disorders. Patients were randomized into two following groups: intravenous paracetamol and IV morphine. Demographic data were similar among groups. Nausea, vomiting scales and anti-emetic requirement of the groups were compared at 0.min, 30.min, 2 hrs and 24 hrs. Analysis had shown that there is a significant difference at the 30th minute, there were no significant differences at other time periods. Wong-Baker faces pain rating scale were compared between groups at 0.min, 30.min, 2 hrs and 24 hrs and no significant differences were seen between group (p > 0.05). Analgesic requirement and sedation scores were compared between groups at 0 min, 30 min, 2 hrs and 24 hrs and no significant differences were seen between groups (p < 0.05). It can be concluded that intravenous paracetamol infusion can safely be used as a replacement to opioids in children undergoing strabismus surgery.

PDF

___

1. Kranke P, Eberhart LH, Toker H, et al. A prospective evaluation of the POVOC Score for the prediction of postoperative vomiting in children. Anesth Analg. 2007;105:1592-7.
2. Eberhart LHJ, Geldner G, Kranke P, et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg. 2004;99:1630-7.
3. Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia Progress, 2010;57:150-7.
4. King CA, Prez-Alvareze IM, Bartholomew AJ. Opioid‐free anesthesia for patients undergoing mastectomy: A matched comparison. Breast J. 2020;26:1742-7.
5. Moller PL, Juhl GI, Payen-Champenois C, et al. Intravenous acetaminophen (paracetamol): comparable analgesic efficacy, but better local safety than its prodrug, propacetamol, for postoperative pain after third molar surgery. Anesth Analg. 2005;101:90-6.
6. Sutters KA, Holdridge-Zeuner D, Waite S, et al. A descriptive feasibility study to evaluate scheduled oral analgesic dosing at home for the management of postoperative pain in preschool children following tonsillectomy. Pain Med. 2012;13:472–83.
7. Sheard RM, Mehta JS, Barry JS, et al. Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: A prospective randomized controlled trial. JAAPOS. 2004;8:314-7.
8. Aksoy M, Ince I, Ahiskalioglu A et al. The effect of intravenous preoperative versus postoperative paracetamol on postoperative nausea and vomiting in patients undergoing strabismus surgery: A prospective randomised study. Agri 2018;30:1-7.
9. Urits I, Orhurhu V, Jones MR, et al. Postoperative nausea and vomiting in pediatric anesthesia. Turk J Anaesthesiol Reanim. 2020;48:88–95.
10. Finley AG, McGrath PJ, Forward PS, et al. Parents’ management of children’s pain following ‘minor’ surgery. Pain. 1996;64:83-7.
11. Carbone LD, Chin AS, Lee TA, et al. The association of opioid use with incident lower extremity fractures in spinal cord injury. J Spinal Cord Med. 2013;36:91-6.
12. Mendel HG, Guarnieri KM, Sundt LM, et al, The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. Anesth Analg. 1995;80:1129-33.
13. Forget P, Tombal B, Scholtès J, et al. Do intraoperative analgesics influence oncological outcomes after radical prostatectomy for prostate cancer? Eur J Anaesthesiol. 2011;28:830-5.
14. Shastri N. Intravenous acetaminophen use in pediatrics. Pediatr Emerg Care. 2015;31:444-8.
15. Bashashati M, McCallum RW. Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. Eur J Pharmacol. 2014;722:79–94.
16. IT. Awad, M. Moore, C. Rushe, et al. Unplanned hospital admission in children undergoing day-case surgery, Eur J Anaesthesiol. 2004;5;379–83.
17. Gurpreet S, Padda OA, Cruz J, Et al. Comparison of postoperative emesis, recovery profile, and analgesia in pediatric strabismus repair; rectal acetaminophen versus intravenous fentanyl-droperidol. Ophthalmology 1997;104;419-24.
18. Munro HM, Rıegger LQ, Reynolds PI, et al. Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery. Br J Anaesth. 1994;72:624‐28.
19. Vallejo MC, Phelps AL, Ibinson JW, et al. Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery. Plast Reconstr Surg. 2012;129:519-26.
20. Oya C, Eker HE, Pelit A, et al. The effect of paracetamol on postoperative nausea and vomiting during the first 24 h after strabismus surgery: a prospective, randomised, double-blind study. Eur J Anaesthesiol. 2011;28:836-41.
21. Högestätt ED, G Jönsson BA, Ermund A, et al. Conversion of acetaminophen to the bioactive N-acylphenolamine AM404 via fatty acid amide hydrolasedependent arachidonic acid conjugation in the nervous system. J Biol Chem. 2005 9;280:31405-12.
22. Moller PL, Juhl GI, Payen-Champenois C, et al, Intravenous acetaminophen (paracetamol): comparable analgesic efficacy, but better local safety than its prodrug, propacetamol, for postoperative pain after third molar surgery. Anesth Analg. 2005;101:90-6.
23. Van Aken H, Thys L, Veekman L, et al. Assessing Analgesia in single and repeated administrations of propacetamol for postoperative pain: comparison with morphine after dental surgery. Anesth Analg. 2004;98:159-65.
24. Hernández-Palazón J, Tortosa JA, Martínez-Lage JF, et al. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg. 2001;92:1473-6.
25. Hungerford JL, O'Brien N, Moore-Clingenpeel M, et al . Remifentanil for sedation of children with traumatic brain injury. J Intensive Care Med. 2019;34:557-62.