22
SF | CPD: PAEDIATRICS
January 2022 | Vol. 22 No. 1
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This article was independently sourced by Specialist Forum.
www.medicalacademic.co.za
IV paracetamol in paediatric patients Please note that our CPD activities are only for practitioners registered with the HPCSA. Any other health professional should apply to their own Council for CPD purposes.
Intravenous (IV) paracetamol is a drug used widely (more than 80 countries worldwide) with substantial experience and data pertaining to both safety and efficacy as both an analgesic and anti-pyretic.1,2
I
t was approved by the American Food and Drug Administration in 2010 for use in children aged two years and above.1,3
Indications for the use of IV paracetamol The indications for the use of IV paracetamol include: _ Treatment of mild to moderate pain and fever when alternate routes of administration are not possible and/or there is an urgent need for therapy _ Treatment of moderate to severe pain as part of a multimodal approach to analgesia (given its’ opioid sparing properties either as an alternative or supplement) _ When opioids are either contraindicated or there are considerable concerns
Dr Kuban D Naidoo, MBBCh (Wits) DCH(SA) FCPaed(SA) MMed [Paeds](Wits) CertCritCare [Paeds](SA)
surrounding the adverse effects of opioids.1-4 IV paracetamol is prominently indicated for post-operative analgesia and has shown efficacy in reducing postoperative nausea and vomiting when used prophylactically. Several studies have demonstrated the adequacy of analgesia while demonstrating less sedation and shorter recovery times.3 Despite the proven efficacy of paracetamol as an analgesic the exact mechanism of action remains incompletely understood. It acts at both central and peripheral components of the pain pathway.2,3 In addition to inhibition of cyclooxygenase enzymes (reduction of prostaglandin production via inhibition of prostaglandin synthase), paracetamol acts on the endogenous opioid, serotoninergic bulbospinal and nitric oxide pathways. 2,3
Senior Paediatric Intensivist, Department of Critical Care, Chris Hani Baragwanath Academic Hospital, Johannesburg
Lastly paracetamol also appears to act on both N-methyl-D-aspartate (NMDA) and cannabinoid CB1 receptors in the brain and spinal cord. 2,3
Rapid onset of action IV paracetamol has a rapid onset of action with analgesic and antipyretic effects within 15 and 30 minutes, respectively. 2,3 The speed of onset of analgesia is due to a rapid time to maximum plasma concentration of 15 minutes as compared to 45 minutes (oral) and three to four hours (rectal). 3 IV paracetamol rapidly crosses the blood-brain barrier achieving higher cerebrospinal fluid (CSF) concentrations and more effective antipyretic effects for the first 60 minutes compared to an equivalent oral dose. Peak analgesic
