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Complete Pain Anest
Complete Pain Anest
Complete Pain Anest
• Rectal suppository:
• Infant and children who do not tolerate oral medication, who are kept strictly NBM or who are
nauseated and vomiting.
• Should be given after induction of anaesthesia for postoperative pain relief.
• Available in doses of 125mg, 250mg, and 500mg.
• Intravenous paracetamol (Perfalgan)
• It provides higher effect site concentration with higher analgesic potency..
• Given as infusion over 15 minutes.
• Dosage based on lean body weight (Less dosage in obese children).
• Given to children over 1 year of age and weight more than 10 kg.
• only in anticipated short duration of therapy (72 hours)
• Indication
• Older children who are fasting or NBM post-operatively and in whom PR administration is
contraindiated or too distressing for the paediatric patient.
• Typically children undergoing laparotomy/ bowel surgery.
• Intra-operative loading of paracetamol for children undergoing long surgical procedures (neurosurgical,
spinal surgery, craniofacial surgery, mutiple trauma orthopaedic surgery, children with mucositis) where
oral intake may be likely be delayed.
Mode of action
• Not completely understood.
• Main mechanism is the inhibition of Cyclooxygenase (COX).
Selectively block COX-3.
• Antipyretic properties - reduced amount of PGE-2 in CNS, lowers the
hypothalamic set-point in the thermoregulatory center, resulting in
peripheral vasodilation, sweating and hence heat dissipation.
• Side effect:
• Nausea, vomiting, stomach pain, loss of appetide, dark urine, jaundice, injection site pain, injection site
reaction
• Precautions:
• Hepatic insufficiency
• Severe renal insufficiency
• G6PD Deficiency
• Chronic alchoholism or excessive alchohol intake
• Anorexia, bulimia, cachexia, chronic malnutrition
• Dehydration and hypovolemia
Step 2: NSAIDS
• Celecoxib (Celebrax)
• Diclofenac (Valtaren)
• Ibuprofen (Advil/ brufen)
• Meloxicam (Mobic)
• Piroxicam (Feldene)
Step 2: NSAIDS
• Parental
• supplement to epidural analgesia or PCA, as a component of multimodal analgesia.
• eg: Parecoxib 40 mg stat followed by 20-40 mg BD for 24 H may be given to postoperative patient on
PCA morphine .
• Oral
• after patients start taking orally and the PCA or epidural has been stopped.
• Suppositories
• Should not be used in neutropenic paediatric patients or who are severely immunocompromised.
• Hypersensitivity reaction
• anaphalactic shock.
COX-2 Inhibitors
Examples Parecoxib (Dynastat)
Celecoxib (Celebrex)
Etoricoxib (Arcoxia)
Dosage IV/IM 40 mg, then 20 or 40 mg 6-12 hrly
Max: 80 mg/day.
Indication Analgesia
Anti-inflammatory effects
Mechanism of Action COX-2 = in response to tissue injury and inflammation
Side Effects Nausea and vomiting
Abdominal pain
Back pain
insomnia, dizziness
MI, deep-vein thrombosis, pulmonary embolism, stroke
renal impairment, increased blood creatinine
Potentially Fatal: Anaphylaxis, Stevens-Johnson syndrome,
toxic epidermal necrolysis.
Tramadol
Class Weak opioid
Half Life 4-6 hours
Indication/Dosage Mod to Sev Pain (Oral)
50-100 mg 4-6 hrly
Ext-rel tab: 50-100 mg 1-2 times/day
Max: 400 mg/day
1. Respiratory Depression
• Possible causes:
• drug interaction – especially if patient is on another drug with sedative effect
• continuous (background) infusion
• inappropriate use of PCA by relatives
• human error
• programming error
• equipment error
2. Nausea & vomiting
3. Pruritus
4. Sedation
Epidural analgesia
This is the introduction of analgesic drugs into epidural space, usually
via an indwelling epidural catheter.
Indications
• Patient refusal
• Untrained staff
• Local infection or general sepsis
• Central neurological disorders e.g. stroke, head injury,
brain tumour
• Coagulation disorders / patient on anticoagulants
• Hypovolemia
Advantages
• Technical difficulty
• High cost of equipment
• Weakness and numbness with local anaesthetics
Drugs used