Janne Rømsing

Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients

Background: In order to establish an effective drug regimen, we compared the analgesic efficacy of oral diclofenac and high‐dose acetaminophen on pain after tonsillectomy.

Diclofenac and metabolite pharmacokinetics in children

Background : Data concerning metabolism of diclofenac in children are limited to intravenous and enteric coated oral formulations. There are no data examining diclofenac or its hydroxyl metabolite pharmacokinetics after rectal administration in children.

Examination of acetaminophen for outpatient management of postoperative pain in children

We have examined acetaminophen (paracetamol) dosing for outpatient management of posttonsillectomy pain in children. Forty children, 5–15 years of age, undergoing tonsillectomy and their parents were randomly assigned to use a scheduled administration of acetaminophen in weight appropriate doses, 60 mg·kg−1·24 h−1 orally, 90 mg·kg−1·24 h−1 rectally, or to use acetaminophen ‘as needed’ according to present standards (control group). Postoperative pain was assessed by the child using the poker chip tool for the first three days after discharge. The prevalence of pain amongst all the children was high. The second day after discharge 22%–64% of the children in the study group and 36%–73% of the children in the control group rated severe pain. Recommended dose ranges of acetaminophen do not provide sufficient pain relief in children following tonsillectomy. Further studies are required to determine, whether higher doses of acetaminophen or analgesics with different analgesic properties will lead to improved analgesia in children following tonsillectomy.

Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy

Background: Tonsillectomy is a common procedure in childhood resulting in significant morbidity due to pain. The aim of this study was to evaluate the analgesic efficacy and safety of a single dose of ketorolac i.v. given before or after tonsillectomy, compared to placebo.

Pain Assessment of Subcutaneous Injections

OBJECTIVE: To compare injection pain after subcutaneous administration of four different solution volumes. DESIGN: Double-blind, randomized, prospective, multiple crossover study. SETTING: Steno Diabetes Centre, Gentofte, Denmark. PARTICIPANTS: Eighteen healthy volunteers, 9 women and 9 men, aged 21-30 years. METHODS: The subjects were injected with four different volumes (0.2, 0.5, 1.0, 1.5 mL) of NaCl 0.9%. The study was performed on 2 days with a 1-week washout period between the study days. On each study day the subjects received four injections in each thigh. To evaluate the validity of our pain assessing model the subjects received eight injections of 0.5 mL on one of the study days. Pain assessment was done immediately after each injection using both a 10-cm visual analog scale (VAS) and a six-item verbal rating scale (VRS). RESULTS: A significant difference in pain score on both the VAS (p < 0.05) and the VRS (p < 0.01) was seen between the four injection volumes. The pain was significantly increased with volumes of 1.0 and 1.5 mL. No significant difference in injection pain could be detected between 0.2 and 0.5 mL and between 1.0 and 1.5 mL. No significant period or carryover effect could be detected in the study. A significant correlation between the pain score on the VAS and the pain score on the VRS was found (r = 0.79, p < 0.0001). CONCLUSIONS: The pain of a subcutaneous injection is related to injection volume in the thigh. The results show that increasing the volume from 0.5 to 1.0 mL increases the pain significantly. The findings from this study should be considered when injection preparations for subcutaneous administration are formulated. The volume should generally be less than 1.0 mL if injected into the thigh.

Pharmacokinetics of oral diclofenac and acetaminophen in children after surgery

Background: Our aim was to study the pharmacokinetics and pain scores following administration of single oral doses of either diclofenac or high‐dose acetaminophen (paracetamol).

Postoperative pain in Danish children: self-report measures of pain intensity.

The Oucher and the Poker Chip Tool are two of the most widely used instruments designed to measure childrens self-report of pain intensity. Most of the studies dealing with the Oucher and the Poker Chip Tool use North American children as subjects. To establish the versatility of the instruments in patients of various cultural backgrounds and with different types of pain, this study used the Oucher and the Poker Chip Tool with 100 Danish children, age 3 to 15 years, after tonsillectomy. Both the Oucher and the Poker Chip Tool provided easy-to-use devices in clinical practice for the estimation of the intensity of the childrens pain. Although the Poker Chip Tool only provides five discrete levels of pain, the strong positive relationships between the pain scores derived from the Oucher and the Poker Chip Tool (r = 0.71-0.79, p < .001) indicate its utility in clinical practice. The Oucher uses actual pictures of a child and therefore demonstrates ethnicity directly. The results of this study suggest that Danish children as well as American children are able to use the Oucher as a method to self-report pain intensity.

Pain prevalence in hospitalized children: a prospective cross‐sectional survey in four Danish university hospitals

Pain management in hospitalized children is often inadequate. The prevalence and main sources of pain in Danish university hospitals is unknown.

Knowledge, attitudes and beliefs of parents regarding fever in children: a Danish interview study

Fever and febrile illness are some of the most common conditions managed by parents. The aim of this study was to examine the knowledge, attitudes and beliefs of parents around fever in children under five years of age.

Structured intervention for management of pain following day surgery in children.

Ambulatory surgery forms a large part of pediatric surgical practice. Several studies indicate that postoperative pain is poorly managed with more than 30% of children having moderate to severe pain. In a busy outpatient clinic contact between healthcare professionals and the family is increasingly limited calling for a global and efficient pain management regime.