ti

c
r
a
N
/
d
o
i
p
O
C
I
S
E
G
L
N
A 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:

 More effective against severe or

acute pain.
 Greater incidence of adverse effects.
 Serious drug dependence and abuse
liability so use is limited in paediatric
dentistry.
 eg. Morphine, cocaine

Cause of Dental Pain:

anti-inflammatory components.

Classification of NSAIDs:
A. Nonselective Cox inhibitors.
 Salicylates: eg. Aspirin
 Less effective against severe or acute
pain.
 Low incidence of adverse effects.
 Low drug dependence and abuse
liability thus has increased scope in
paediatric dentistry.
 eg. Ibuprofen, diclofenac, nimesulide

Mostly, dental pain is inflammatory in origin and hence responds well to drugs with
  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 suppository’s 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 Reye’s 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.
 REYE’s 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 Reye’s 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.