Do you have any expierence with paracetamol for analgesia in preterm infants, especially after surgery?

Which dosis and how often do you administer?

The following guidelines are from the Swedish Pediatr Pain group.

If you read Swedish....http://www.svenskbarnsmartforening.se/svenskbarnsmartforening/dokument/nyfoddhetssmarta.pdf

I translate the dosing recommendations:

PO or PR doses

28-31 weeks (gest.age): 25 mg/kg loading dose, thereafter 15 mg/kg every 12 hour (x2)

32-36 weeks: 25 mg/kg loading dose, thereafter 15 mg/kg every 8 hour (x3)

> 36 weeks: 25 mg/kg loading does, thereafter 15 mg/kg every 6 hour (x4)

IV doses (infusion time 30 min)

28 – 31 weeks: 7,5 mg/kg every 12 hour (x2)

> 32 weeks: 7,5 mg/kg every 6 hour (x4)

Term infants AND >1 weeks postnatal age: 10 mg/kg every 6 hour (x4)

A quit interesting article about (i.v.) paracetamol, dosage and analgesic effect:

Arch Dis Child Fetal Neonatal Ed. 2004 Jan;89(1):F25-8.

Pharmacokinetics of single dose intravenous propacetamol in neonates: effect of gestational age.

Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721651/?tool=pubmed

Greetings Dirk

In Canada we don't have IV acetaminophen. We do use PO/PR and the dosing guideline that we use at my hospital is from Anderson, Brian et al. Anesthes.2002; 96:1336-45. This is a good article wherein the authors looked at the available information on acetaminophen kinetics in neonates (up to 2002) and made dosing recommendations. They are similar to the one posted by Dr. Johansson above, but with higher loading dose of 35 mg/kg for rectal, and for the under 30 wk group, with PO dosing the maintenance dose is lower - 12 mg/kg. After surgery we'd usually use IV morphine for a few days, then transition to acetaminophen PR. We try to stop in 72 hours.

The main problem with paracetamol/acetaminophen in PO/PR formulations is that there is only sparse data on efficacy. There is no evidence (to my knowledge) on the dose we should use to attain analgesic effect as measured by validated pain scales. I know of four studies that looked at the efficacy of paracetamol PR but failed to show analgesic effect. One study looked at paracetamol PO and also failed to show analgesic effect (if someone is interested in the references I will be glad to give them, but I don't have them at home right now) . In a study by Sinno Simons et al paracetamol failed to reduce the need for morphine post-op. The only study on paracetamol i.v. showing analgesic effect was published in 2004 (Allegaert K, Anderson BJ, Naulaers G, de HJ, Verbesselt R, Debeer A, Devlieger H, Tibboel D. Intravenous paracetamol (propacetamol) pharmacokinetics in term and preterm neonates. Eur J Clin Pharmacol. 2004;60:191–197).