Assessment and treatment of pain in pediatric patients.
Curr Pediatr Res 2017 Volume 21 Issue 1
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toxic
metabolite acetyl-p-benzoquinone-imine (NAPQI)
is produced in high quantities. This may lead infants
and children to hepatotoxicity. However, rodent study
compared weanling to adult rats and suggested that infants
produce high levels of sulfhydryl group of glutathione
(GSH) to bind NAPQI as a part of hepatic growth and this
may provide some protection against the hepatotoxicity
produced by overdose [7].
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are commonly used analgesics with less
contraindication in relative to opioids. Mainly these are
used as analgesic regimen in mild and moderate pain
by preventing the conversion of arachidonic acid to
prostaglandins and thromboxane. Prostaglandins are
pr
o inflammatory mediators that sensitize nociceptors to
increase afferent nociceptive signal to pain. Diclofenac,
ketoprofen and ibuprofen commonly used NSAIDs in
pediatric practice [7]. An observational study on the use
of non-steroidal anti-inflammatory drugs (NSAIDs) was
done in a sample of 51 patients in Italy resulted that
ibuprofen was the most (68.6%) used NSAID followed
by ketoprofen 9.8% and acetylsalicylic acid 7.8% for pain
management of in pediatrics. The use of NSAIDs is now
well established in clinical pain management [47].
This show to decrease morphine consumption and improve
the quality of analgesia without increasing the incidence of
side effects. These drugs are now a standard peri-operative
analgesic agent in many pediatric institutions. Ibuprofen
mainly used is available in oral suspension, infant drops,
Figure 3.
The WHO analgesic ladder [15,24,45]
Drug
Oral peak time Usual Pediatric
dosage
Usual Adult dosage
Comments
Acetaminophen
0.5–2 h
10–15 mg/kg every
4 h orally
20-40 mg every 6 h
rectally
650–1000 mg every 4 h
Lacks the peripheral anti-
inflammatory activity of other
NSAIDs
Choline magnesium
trisalicylate
(Trilisate)
2 h
25 mg/kg every
12 h
1000–1500 mg every
12 h
Does not increase bleeding time
like other NSAIDs; available as
oral liquid
Ibuprofen
0.5 h
6–10 mg/kg every
6–8 h
200–400 mg every
4–6 h
Fewer GI effects than other non-
selective NSAIDs
Naproxen
2–4 h
5 mg/kg every 12 h
250–500 mg every
6–8 h
Delayed-release tablets are not
recommended for initial treatment
of acute pain
Ketorolac
0.75–1 h
0.25–0.5 mg/kg IV
or IM, every 6 h
30 mg IV loading dose,
then 15–30 mg every
6 h
IV or IM use only in children less
than 50 kg; should not be used for
children with bleeding disorder or
at risk for bleeding complications
Celecoxib
3-6 h
1-2 mg/kg
100-200 mg every 12 h
sparing of COX-1 reduces the
risk of serious GI side effects and
renal toxicity Also, no effects on
platelet aggregation
Table 4.
Dosage guidelines for the common non-opioids used in the management of pain in pediatrics [12,48]
