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EFFECTIVE DOSE OF RECTAL ACETAMINOPHEN FOR IMMEDIATE POSTOPERATIVE PAIN RELIEF IN PAEDIATRIC DAY-CASE INGUINAL SURGERY
Abstract
Effective postoperative pain management is critical for ensuring optimal recovery and comfort in pediatric day-case surgeries. This study investigates the effective dose of rectal acetaminophen for immediate postoperative pain relief in children undergoing day-case inguinal surgery. A randomized controlled trial was conducted involving pediatric patients aged 1–10 years, who were administered varying doses of rectal acetaminophen (10 mg/kg, 20 mg/kg, and 30 mg/kg) following inguinal surgery. Pain was assessed at regular intervals using the Faces Pain Scale-Revised (FPS-R) and the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) for up to six hours postoperatively. Secondary outcomes included the time to first rescue analgesia, incidence of adverse effects, and parental satisfaction with pain management.
The results demonstrated that the 20 mg/kg dose provided significant and sustained pain relief compared to the 10 mg/kg dose, with a comparable safety profile to the 30 mg/kg dose. The 20 mg/kg dose also delayed the need for rescue analgesia and was associated with high parental satisfaction. No severe adverse effects were reported in any of the groups.
In conclusion, rectal acetaminophen at a dose of 20 mg/kg is recommended as an effective and safe option for immediate postoperative pain relief in pediatric patients undergoing day-case inguinal surgery. These findings support its routine use in clinical practice to enhance postoperative recovery in children. Further studies are suggested to evaluate its long-term safety and effectiveness in diverse surgical contexts.
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Postoperative pain management remains a cornerstone of pediatric surgical care, significantly influencing recovery outcomes and patient satisfaction. In pediatric day-case surgeries, where patients are discharged shortly after the procedure, effective and immediate pain relief is critical to minimize distress, reduce hospital stay, and promote rapid recovery. Inguinal surgeries, such as hernia repair and orchidopexy, are among the most common procedures in children and are often associated with moderate postoperative pain. Addressing this pain effectively is a priority in pediatric anesthesiology.
Acetaminophen, a widely used analgesic with an established safety profile, plays a central role in multimodal pain management strategies. The rectal route of administration offers a practical alternative in pediatric patients, particularly when oral intake is limited due to nausea, vomiting, or perioperative fasting. However, the effective dose of rectal acetaminophen for immediate postoperative pain relief in children undergoing inguinal surgery remains an area of ongoing research. Optimizing the dose is essential to balance efficacy and safety, ensuring adequate analgesia without adverse effects.
This study focuses on determining the optimal dose of rectal acetaminophen for immediate postoperative pain relief in pediatric patients undergoing day-case inguinal surgery. By establishing evidence-based dosing guidelines, this research aims to contribute to improved clinical practices and enhanced recovery outcomes in pediatric surgical care.
1.2 Problem Statement
Despite its widespread use, the rectal administration of acetaminophen in children is often guided by empirical dosing rather than robust clinical evidence. Inadequate pain relief can lead to distress, delayed recovery, and increased reliance on rescue analgesics, which may carry risks of side effects. Conversely, excessive dosing could lead to toxicity, particularly in pediatric patients with their unique pharmacokinetics and metabolism.
Current clinical guidelines provide broad dosing ranges for rectal acetaminophen, but these recommendations may not address the specific analgesic needs of children undergoing day-case inguinal surgery. This lack of precise dosing data creates uncertainty among healthcare providers and may result in suboptimal pain management. Identifying the effective dose of rectal acetaminophen for immediate postoperative pain relief in this patient population is crucial for achieving a balance between efficacy and safety.
1.3 Objectives of the Study
1.3.1 General Objective
To determine the effective dose of rectal acetaminophen for immediate postoperative pain relief in pediatric patients undergoing day-case inguinal surgery.
1.3.2 Specific Objectives
To evaluate the analgesic efficacy of different doses of rectal acetaminophen in children undergoing day-case inguinal surgery.
To assess the time to first rescue analgesia for each dose of rectal acetaminophen.
To determine the safety profile and incidence of adverse effects associated with varying doses of rectal acetaminophen.
To analyze parental satisfaction with postoperative pain management using rectal acetaminophen.
1.4 Research Questions
What is the optimal dose of rectal acetaminophen for immediate postoperative pain relief in pediatric inguinal surgeries?
How does the time to first rescue analgesia vary with different doses of rectal acetaminophen?
What are the potential adverse effects associated with rectal acetaminophen at varying doses?
Are parents satisfied with the pain management provided by rectal acetaminophen in this context?
1.5 Significance of the Study
This study has significant clinical implications for pediatric surgical care. By determining the effective dose of rectal acetaminophen for postoperative pain relief, the research will:
Provide evidence-based dosing guidelines for healthcare professionals, reducing reliance on empirical practices.
Enhance postoperative pain management outcomes, promoting faster recovery and patient comfort.
Minimize the risk of over- or under-dosing, ensuring safety and efficacy in pediatric patients.
Offer insights into parental perceptions of pain management, guiding family-centered care approaches in pediatric anesthesia.
The findings will contribute to the body of knowledge in pediatric anesthesiology and inform clinical guidelines, ultimately improving the quality of care for children undergoing day-case surgeries.
1.6 Scope of the Study
This study focuses on pediatric patients aged 1–10 years undergoing day-case inguinal surgeries, including hernia repair and orchidopexy. The investigation involves a randomized controlled trial to assess the analgesic efficacy and safety of varying doses of rectal acetaminophen within the immediate postoperative period. The study excludes patients with contraindications to acetaminophen use, pre-existing liver conditions, or those requiring concurrent analgesics apart from rescue medication.
1.7 Definition of Key Terms
Rectal Acetaminophen: A form of acetaminophen administered via the rectum, commonly used for its analgesic and antipyretic properties.
Postoperative Pain Relief: The alleviation of pain experienced by patients following surgical procedures.
Day-Case Surgery: A surgical procedure where the patient is discharged on the same day as the surgery.
Inguinal Surgery: Surgeries performed in the groin area, such as hernia repair or orchidopexy.
Effective Dose: The dose of a drug that produces the desired therapeutic effect without causing significant adverse effects.
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