Optimizing Postoperative Analgesia for Children

Abstract

Objectives:

(1) Analyze the difference between prescribed doses and manufacturer recommended doses of acetaminophen and ibuprofen for pediatric otolaryngology patients in the postoperative setting. (2) Highlight a problem with manufacturer dosing advice for over-the-counter analgesics.

Methods:

We selected 53 consecutive children who had otolaryngology operations requiring general anesthesia in 2013. These children were discharged with instructions to use over-the-counter analgesia, as per current departmental practice. We compared the manufacturer recommended doses of generic over-the-counter acetaminophen and ibuprofen with doses of the same analgesics that they would have had as inpatients during the postoperative period.

Results:

Manufacturers often recommend a range of doses. With acetaminophen, even when assuming the highest recommended doses were used, we found that children would have received on average 16% less acetaminophen than they would have had in hospital. (P = .048). With ibuprofen, assuming the lowest recommended doses were used, children would receive 25% less ibuprofen than as inpatients (P = .037). If the highest recommended doses were used, they would have taken 7% more ibuprofen than we would have found safe to prescribe (P = .06).

Conclusions:

Over-the-counter acetaminophen and ibuprofen come with dosing advice guided by age. Our analysis demonstrated that this could often be substantially different from the ideal dose, which is based on the child’s weight. With the global trend of increasing body weight, we can expect this disparity to get bigger in the future. Good pain management is important in pediatric otolaryngology, but this result is relevant to all clinicians caring for children.