الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Recently more emphasis has been placed on the reduction of postoperative pain as it may lead to subsequent drawbacks which appears long after surgery.
The practice of treating pain only after it had been established is slowly being supplanted by a preventive approach. The idea behind pre-emptive analgesia is not simply that it reduces nociception and stress during surgery, although these are obviously worthwhile goals, but also reducing pain intensity and lower analgesic requirements even after the analgesic effects of the (pre-emptive) agents have worn off.
The aim of this study was to evaluate and compare the efficacy of intravenous Acetaminophen, ketorolac and their combination as pre-emptive analgesics before elective orthopedic surgery in school age patients.
This study was carried out on 180 pediatric patients between the age of 7 to 12 years of both sexes (ASA class I and II) scheduled for elective orthopedic surgeries under general anesthesia. Patients were randomly allocated into one of three groups (60 patients each) according to the drug studied.
- Group I patients received a single bolus of intravenous Acetaminophen (100 cc prepared vial of 1 gm) at a dose of 15 mg/kg 5 minutes before skin incision.
- Group II patients received a single dose of intravenous ketorolac Tromethamine (0.5mg / kg ) 5 minutes before skin incision.
- Group III patients received a single bolus of intravenous Acetaminophen (100 cc prepared vial of 1 gm) at a dose of 15 mg/kg and a single dose of intravenous ketorolac Tromethamine (0.5 mg/kg) 5 minutes before skin incision.
All patients received induction of anesthesia by intravenous propofol 3 mg/kg followed by fentanyl 1 µg/kg and atracurium (0.5 mg / kg I.V.) to facilitate endotracheal intubation with a cuffed tube. Anesthesia was maintained with isoflurane 1.5-1.8 % in oxygen and mechanical ventilation.
The following measurements were taken:
1. Vital signs:
a- Continuous ECG monitoring for detection of dysrhythmias.
b- Respiratory Rate.
c- Noninvasive arterial blood pressure: systolic, diastolic and mean (mmHg)
d- Oxygen saturation (%) throughout the whole procedure.
Heart rate, respiratory rate,SpO2 and blood pressure were recorded as follows: Before induction of anesthesia, at 0 minute after skin incision, every 15 minutes during operation till the end of procedure and every 10 minutes in the recovery room for 30 minutes, then every 2 hours for 6 hours in the ward.
2- Response of the first surgical stimulus as indicated by arterial blood pressure pulse rate and ECG changes.
3- Postoperative pain was assessed by objective pain scale every 10 minutes in the recovery room and every 2 hours for 6 hours in the ward. Frequency and timing of rescue analgesic dose given in the form of 0.05 mg/kg i.v Morphine if severe pain 7-10 pain score were also recorded.
The following results were found in the three studied groups:
• There were no significant differences as regards age, sex, weight and the type and duration of operation.
• There were no significant differences in the respiratory rate and spo2 in the preoperative or postoperative readings.
• No hypotension was recorded intraoperatively or postoperatively (i.e. reduction in the MABP more than 20 % from the pre-induction level) and no significant differences between the groups.
• There were no reduction in SpO2 values; the least value recorded was 98% on room air.
• There were statistically significant differences between the Acetaminophen ,ketorolac and combination groups as regards the postoperative pain at the different study times where less patients showed severe pain ( over 7 on objective pain scale) in group III (combination group).