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Effect of intraoperative intravenous acetaminophen vs. intramuscular meperidine on pain and discharge time after paediatric dental restoration

Published online by Cambridge University Press:  08 August 2006

J. A. Alhashemi  and
M. F. Daghistani
J. A. Alhashemi
Affiliation:
King Abdulaziz Medical City, Department of Anesthesia, Jeddah, Saudi Arabia
M. F. Daghistani
Affiliation:
King Abdulaziz Medical City, Department of Anesthesia, Jeddah, Saudi Arabia
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Abstract

Summary

Background and objective: Enteral acetaminophen (paracetamol) has limited analgesic efficacy due to its delayed absorption and sub-therapeutic plasma concentration. Intravenous (i.v.) acetaminophen solves this issue and could thus provide adequate analgesia as a single agent. We compared intraoperative i.v. acetaminophen with intramuscular (i.m.) meperidine with regard to postoperative analgesia and readiness for discharge in paediatric patients undergoing day care dental restoration. Methods: Forty children were randomized, in this double-blind study, to receive acetaminophen 15 mg kg−1 i.v. (Group A) or meperidine 1 mg kg−1 i.m. (Group M) after anaesthesia induction and before surgery. All patients received midazolam 0.5 mg kg−1 orally 30 min preoperatively and fentanyl 1 μg kg−1 i.v. immediately after induction. Anaesthesia was induced with either sevoflurane inhalation or propofol 3 mg kg−1 i.v. and was maintained with sevoflurane. Postoperatively, the objective pain scale, Ramsay sedation score, and Aldrete score were determined every 5 min until readiness for recovery room discharge (defined as achieving an Aldrete score of 10). Results: Group A had slightly higher pain scores during early recovery compared with Group M (estimated marginal means: 3 ± SEM 0.4 vs. 2 ± SEM 0.4, respectively (95% CI for difference: 0.4, 2.6), P = 0.012 for F-test). In contrast, Ramsay scores were higher in Group M than in Group A during assessment period (estimated marginal means: 4 ± SEM 0.3 vs. 2 ± SEM 0.4, respectively (95% CI for difference: −2.3, −0.3), P = 0.013 for F-test). Group A patients achieved an Aldrete score of 10 sooner than those in Group M (5 ± SEM 2 vs. 16 ± SEM 4 min, respectively (95% CI for difference: −9, −14), P = 0.009). Conclusion: Compared with i.m. meperidine, intraoperative i.v. acetaminophen resulted in slightly higher pain scores but earlier readiness for recovery room discharge in paediatric patients undergoing dental restoration. The potential economic benefit of early recovery room discharge needs to be further explored.

Keywords

NON-NARCOTIC ANALGESICS, acetaminophenNARCOTICS, meperidineANALGESIA, postoperative, pre-emptiveDENTAL RESTORATIONDENTAL CARIESPAEDIATRICSPATIENT DISCHARGE, recovery room
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 128 - 133
Copyright
2007 European Society of Anaesthesiology

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