title: A comparison of rectal and intramuscular codeine phosphate in children following neurosurgery.
abstract: Codeine is frequently used for postoperative analgesia in children. Intramuscular injections are not ideal and the rectal route may be preferable. We compared rectal and intramuscular codeine administered following neurosurgery. 20 children (over 3 months) undergoing elective neurosurgical procedures, were randomized to receive either rectal or intramuscular codeine phospate (1 mg.kg-1) at the end of the procedure. Serum levels of codeine and morphine were assayed at intervals following administration (0, 30, 60, 120, 240 min). Fentanyl was the intraoperative analgesic and postoperative rescue analgesia was paracetamol, diclofenac and intramuscular codeine. The Children's Hospital of Eastern Ontario Pain Scale was used to assess analgesia. Peak codeine levels in both groups were observed at 30 min and morphine levels were consistently low. The plasma codeine levels were significantly greater at 30 and 60 min following intramuscular injection, and were associated with slightly better analgesia scores, but did not reach statistical significance. However, the peak plasma level occurred at similar times in both groups. Codeine is absorbed as rapidly via the rectal route compared with the intramuscular route but the peak levels are lower.
authors.affiliation: Department of Anaesthetics, Great Ormond Street Hospital for Children NHS Trust,Great Ormond Street, London WC1N 3JH, UK.
authors.forename: A
authors.initials: A
authors.lastname: McEwan
authors.forename: P E
authors.initials: PE
authors.lastname: Sigston
authors.forename: K A
authors.initials: KA
authors.lastname: Andrews
authors.forename: H A
authors.initials: HA
authors.lastname: Hack
authors.forename: A M
authors.initials: AM
authors.lastname: Jenkins
authors.forename: L
authors.initials: L
authors.lastname: May
authors.forename: N
authors.initials: N
authors.lastname: Llewelyn
authors.forename: A
authors.initials: A
authors.lastname: MacKersie
mesh_terms: D000042:Absorption; D000082:Acetaminophen / Q000627:therapeutic use; D000285:Administration, Rectal; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000097:blood; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage* / Q000097:blood; D004008:Diclofenac / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009020:Morphine / Q000097:blood; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D013223:Statistics as Topic; D013488:Suppositories
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac; D000082:Acetaminophen; D009020:Morphine; D005283:Fentanyl; D003061:Codeine