to investigate the effectivness of preemptive analgesia with rectal paracetamol in children undergone neurosurgical interventions.
with informed consent from parents we enrolled 16 children under 1 year underwent ventriculo-peritoneostomy. Monitoring included pulse oximetry, HR, ECG, NIBP, ETcapnography (Nihon Kohden, Siemens KION). Premedication: oral midazolam (0,08 mg/kg); total intravenous anesthesia: fentanyl (3, 5 mcg/kg/h), propofol (2, 5 mcg/kg/h); neuromuscular block: pipecuronium (0,1 mg/kg). Patients received preemptive analgesia with rectal paracetamol before incision (10 mg/kg). In postoperative period all the patients had been receiving rectal paracetamol (10 mg/kg) every 8 hours for two days. Blood samples were taken before anesthesia induction, during the operation and the next morning. We investigated prolactine, cortisol levels (IMMULITE). Also we assessed patient's pain with biobehavioral scales (NIPS, CHIPPS, CRIES).
before operation there were age-related normal hormone levels. We observed intraoperative increase of prolactine concentration. On the 1st postoperative day prolactine concentration decreased significantly comparing to intraoperative levels. Levels of cortisol during anesthesia and on the first postoperative day also decreased comparing to preoperative levels. There was a statistically significant difference (P < 0,05) between preoperative and postoperative levels of stress hormones. Biobehavioral scales in postoperative period showed 0–2 grades in all patients that indicated pain absence.
decreasing of stress-hormones levels demonstrated that the preemptive analgesia with rectal paracetamol provides physiologically appropriate level of postoperative analgesia after neurosergical operations in children.
© 2012 European Society of Anaesthesiology