Single High-Dose Rectal Acetaminophen in Children

Abstract

OBJECTIVE To determine whether there is sufficient evidence to support the use of one-time high-dose (>30 mg/kg) rectally administered acetaminophen to control postoperative pain in children. DATA SOURCES Literature was accessed through MEDLINE (1966–May 2004) and bibliographic searches. STUDY SELECTION AND DATA EXTRACTION All articles identified from the data sources were evaluated and all studies regarding the use of greater than 30 mg/kg of acetaminophen in children were included for this review. DATA SYNTHESIS A single high dose of rectally administered acetaminophen has been used in children to control postoperative pain. Ten randomized controlled trials and pharmacokinetic studies evaluating the use of greater than 30 mg/kg of rectally administered acetaminophen in children were identified and reviewed. Each study had a unique objective. The studies also differed substantially in regard to design, study population, dosing, rectal formulation used, and monitoring. CONCLUSIONS Due to limited study data, wide study variability, and lack of standardization in terms of design, objectives, study population, dosing, rectal formulation, and monitoring, compounded by the fact that children often require additional doses of acetaminophen to control postoperative pain, the practice of using one-time, high-dose, rectally administered acetaminophen in children cannot be recommended at this time.