The Pharmaceutical Journal
Vol 269 No 7214 p308
7 September 2002

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Queen's University of Belfast (www.qub.ac.uk)

Post-operative paediatric analgesic doses may be too low to be effective

Children may be receiving inadequate pain relief after operations, research conducted by pharmacists at the Queen's University of Belfast suggests.

The researchers, led by Professor James McElnay, head of the university's school of pharmacy, analysed more than 1,000 blood samples from almost 500 children. They used an analytical technique called sparse data analysis to estimate the pharmacokinetics and pharmacodynamics of a range of drugs used in paediatric medicine. Beneficial and adverse effects experienced by the children were also monitored.

One of the drugs they looked at was diclofenac, used widely to treat post-operative pain in children. They found that 42.1 per cent of children were still experiencing moderate pain after being given diclofenac. In 1.3 per cent of cases, the pain was recorded as severe.

"We tried to assess the effectiveness of pain relief and in many cases, it was effective," Dr Paul Collier, senior lecturer at Queen's, told The Journal. "However, in a small percentage of children, pain relief was inadequate." Dr Collier added that at the doses used, there was generally a lack of expected side effects. "We need to investigate whether there is scope for increasing doses," he said.

The researchers say that because medicines are often not licensed for use in children, the information necessary to treat them effectively is not available. In addition to diclofenac, they studied the effects of ranitidine, enalapril, paracetamol, ibuprofen and midazolam. They plan to use the results of the study to produce a database. "The findings will give confidence to prescribers when using the study drugs within a clinical setting. As a general rule, the doses selected by clinicians were appropriate and safe. The control of symptoms were, however, not optimal in all cases, most notably in the control of pain," the researchers conclude.

The three-and-a-half-year study, which has not been published, was funded by the children's charity Action Research.

See Comment, p306