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ページを印刷するAssessment and treatment of pain in pediatric patients.
Table 4. Dosage guidelines for the common non-opioids used in the management of pain in pediatrics [12,48]
Drug
Oral peak time
Acetaminophen
Choline magnesium
trisalicylate
(Trilisate)
Ibuprofen
Naproxen
Ketorolac
Celecoxib
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
Curr Pediatr Res 2017 Volume 21 Issue 1
Figure 3. The WHO analgesic ladder [15,24,45]
Usual Pediatric
dosage
10–15 mg/kg every
4 h orally
0.5–2 h
20-40 mg every 6 h
rectally
25 mg/kg every
2 h
12 h
6–10 mg/kg every
0.5 h
6–8 h
2–4 h
5 mg/kg every 12 h
0.25–0.5 mg/kg IV
0.75–1 h
or IM, every 6 h
3-6 h
1-2 mg/kg
Usual Adult dosage Comments
650–1000 mg every 4 h
1000–1500 mg every
12 h
200–400 mg every
4–6 h
250–500 mg every
6–8 h
30 mg IV loading dose,
then 15–30 mg every
6 h
100-200 mg every 12 h
pro 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,
Lacks the peripheral anti-
inflammatory activity of other
NSAIDs
Does not increase bleeding time
like other NSAIDs; available as
oral liquid
Fewer GI effects than other non-
selective NSAIDs
Delayed-release tablets are not
recommended for initial treatment
of acute pain
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
sparing of COX-1 reduces the
risk of serious GI side effects and
renal toxicity Also, no effects on
platelet aggregation
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