Evidence map›Paper›PMID 23570544›Full record

SynthesisPaediatric anaesthesia2013

Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children.

Ivan Wong, Celia St John-Green, Suellen M Walker

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Paediatric anaesthesia, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02248493 (The Effect of Intravenous Paracetamol in Combination With NSAIDs for Postoperative Pain in Children), which is not on this map. Cited by 61 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 4 pooled it
24.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02248493 phase4completednot on this map

The Effect of Intravenous Paracetamol in Combination With NSAIDs for Postoperative Pain in Children

TypeinterventionalSponsorLithuanian University of Health SciencesRan2012 to 2017Enrolled54ConditionsPain, Postoperative, Recovery of Function, ChildArmsParacetamol, Placebo (for paracetamol), Ketoprofen, Tramadol, Morphine
3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 4 syntheses or guidelines pooled it, 197 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Guideline
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Article
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  11. Review
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  15. Article
  16. The Three W's of Acetaminophen In Children: Who, Why, and Which Administration Mode.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2023
    Article
  17. Article
  18. Review
  19. Multimodal Pain Management in Orthopedic Surgery.Journal of clinical medicine · 2022
    Review
  20. Anesthesia and cancer recurrence: an overview.Journal of anesthesia, analgesia and critical care · 2022
    Review

1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 1 country.

Ivan WongDepartment of Anaesthesia, Great Ormond St Hospital for Children NHS Foundation Trust, London, UK.
Celia St John-Green
Suellen M Walker
Addenbrooke's Hospital · GBGreat Ormond Street Hospital for Children NHS Foundation Trust · GBUniversity of Cambridge · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesPerioperative pain in children can be effectively managed with systemic opioids, but addition of paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce opioid requirements and potentially improve analgesia and/or reduce adverse effects.

methodsA systematic literature search was conducted to identify trials evaluating postoperative opioid requirements in children and comparing NSAID and/or paracetamol with placebo. Studies were stratified according to design: continuous availability of intravenous opioid (PCA/NCA) vs intermittent 'as needed' bolus; and single vs multiple dose paracetamol/NSAIDs. Primary outcome data were extracted, and the percentage decrease in mean opioid consumption was calculated for statistically significant reductions compared with placebo. Secondary outcomes included differences in pain intensity, adverse effects (sedation, respiratory depression, postoperative nausea and vomiting, pruritus, urinary retention, bleeding), and patient/parent satisfaction.

resultsThirty-one randomized controlled studies, with 48 active treatment arms compared with placebo, were included. Significant opioid sparing was reported in 38 of 48 active treatment arms, across 21 of the 31 studies. Benefit was most consistently reported when multiple doses of study drug were administered, and 24 h PCA or NCA opioid requirements were assessed. The proportion of positive studies was less with paracetamol, but was influenced by dose and route of administration. Despite availability of opioid for titration, a reduction in pain intensity by NSAIDs and/or paracetamol was reported in 16 of 29 studies. Evidence for clinically significant reductions in opioid-related adverse effects was less robust.

conclusionThis systematic review supports addition of NSAIDs and/or paracetamol to systemic opioid for perioperative pain management in children.

Indexed as

AcetaminophenAdolescentAnalgesia, Patient-ControlledAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalChildChild, PreschoolDose-Response Relationship, DrugFemaleFentanylHumansInfantInfant, NewbornMaleMorphineAcetaminophenAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalFentanylMorphine

Identifiers

PMID23570544
PMCPMC4272569
OpenAlexW2132933081

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.