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ANALGESICS FOR CHILD PATIENT

Algesia(Pain):
It is an ill defined unpleasant sensation usually evoked by an
external or internal noxious stimulus.

Analgesic:
A drug that significantly relieves pain by acting in central nervous
system or on peripheral pain mechanism without significantly altering
consciousness.

Pain is most important symptom that brings the patient to the doctor.
Excessive Pain is unbearable. Analgesics relieve pain as a symptom
without affecting its cause.

Classification:
ONA o n
spN t e r o i d a l
A
ai n t i -
L
ioG n fl a m m a
tiE o r y
S
d r u g s ( N S
I
A/C I D )
NS
a
r
c
o
t i
c

More effective against severe Less effective against severe


or acute pain. or acute pain.
Greater incidence of adverse Low incidence of adverse
effects. effects.
Serious drug dependence and Low drug dependence and
abuse liability so use is abuse liability thus has
limited in paediatric dentistry. increased scope in paediatric
dentistry.
eg. Morphine, cocaine eg. Ibuprofen, diclofenac,
nimesulide
Cause of Dental Pain:
Mostly, dental pain is inflammatory in origin and hence responds
well to drugs with anti-inflammatory components.

Classification of NSAIDs:
A. Nonselective Cox inhibitors.
Salicylates: eg. Aspirin
Propionic acid derivatives: eg. Ibuprofen
Aryl acetic acid derivatives: eg. Diclofenac

B. Preferential (Selective) Cox-2 inhibitors.


eg. Nimesulide

C. Analgesic-Antipyretic with poor anti-inflammatory


action.
eg. Paracetamol

Individual Drugs:
1) Ibuprofen:

Trade name:
Brufen, Emflam, Ibusynth-200,400,600 mg tab. Ibugesic-100 mg/5 ml
suspension.

Mode of action:
They inhibit Prostaglandin (PG) synthesis.
To some extent inhibit platelet aggregation and prolong bleeding time.

Uses:
In mild to moderate pain.

Dose:
10-15 mg/kg body weight in divided doses every 8 hourly.

Adverse effects:
Mild and incidence is low.

Gastric discomfort, nausea & vomiting.


Gastric erosion & occult blood loss occur rarely.

Contraindications:
Peptic ulcer, bronchial asthma, hypersensitivity, severe renal disease.
2) Paracetamol.

Trade name:
Crocin, Metacin 0.5 & 1 gm tab., 125 mg/5 ml syrup, 150 mg/ml paediatric
drops. Neomol, Febrinil 300 mg/2 ml injection.

Mode of action:
Good antipyretic but mild anti inflammatory action. More active on COX in
brain.

Uses:
Safest drug in mild pain.
In moderate pain, combination of Paracetamol with other drugs
produces synergistic effect due to different mode of action.

Dose:
14-15 mg/kg body weight in divided doses every 6 hourly.

Adverse effects:
Nausea, rashes occasionally.
Leucopoenia occurs rarely.
Nephropathy after years of heavy ingestion.

Acute Paracetamol poisoning:


Common in children with hepatotoxicity. Toxicity occurs if dose >150
mg/kg body weight.

Contraindications:
Analgesic nephropathy, jaundice, not recommended in premature infants
with <2 kg body weight.

3) Diclofenac:

Trade name:
Voveran, Diclonac 50 mg enteric coated, 100 mg SR tablet, 25 mg/ml in
3 ml ampule injection.

Mode of action:
Inhibits PG synthesis, short lasting anti-platelet action.

Uses:
In moderate to severe pain, widely used post operatively.
Diclofenac suppositorys use post operative is increasing as its
absorption is rapid (as good as IM or IV) and adverse effects i.e.
nausea, vomiting are less.
Dose:
1-3 mg /kg body weight in equally divided doses 3 times a day.

Adverse effects:
Epigastric pain, nausea, rashes.
Nephrotoxicity, blood dyscrasias.

Contraindications:
Hypersensitivity to NSAID, peptic ulcer, asthma.

4) ASPIRIN:

Trade name:
Aspirin, Colsprin, Ecosprin, Disprin 100,350,650 mg

Mode of action:
Inhibits PG and Thromboxane A2 synthesis.

Inhibit COX non-selectively

Uses:
Should not be used in child patient due to Reyes syndrome (rare form
of hepatoencephalopathy).

Dose:
30-65 mg /kg body weight 6 hourly.

Adverse effects:
Therapy in children with rheumatoid arthritis found to raise serum
transaminases, indicating liver damage.
REYEs Syndrome
In long term therapy, high dose aspirin can cause insidious onset
hepatic injury.
Gastric irritation, peptic ulcer.
Acute Poisoning:
It is more common in children. Fatal dose is 15-30 g in adults and
less in children considerably.

Contraindications:
Avoided by breast feeding mother, peptic ulcer, chronic liver diseases.
Paediatric formulations are prohibited in India and UK due to Reyes
Syndrome.
5) NIMESULIDE:

Trade name:
Nimulid, Nimegesic, Nimodol 100 mg tab, 50 mg/5 ml suspension.

Mode of action:
Selective COX-2 (Cyclo-oxygenase) inhibitor.

Uses:
Banned for paediatric use due to several instances of fulminant
hepatic failure in children.

Prescription writing
Dr ABC
BDS
Address
Date
For XYZ,
Age/Sex
Address
R

Tablet/Capsule ______________ _____ mg


Take 1 tablet 3 times a day every 8 hours for 3 days.
ABC
Reg. No: xxxx
SEMINAR ON
ANALGESICS FOR CHILD
PATIENT

Submitted to:
Department of Pedodontics
K. M. Shah Dental College

Prepared by:
Bhatia Yashpreetsingh A.
Under the Guidance of:
Dr. Rachappa M.M.

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