Nonsteroidal anti-inflammatory drugs and paracetamol in children.

The cyclooxygenase enzymes produce large amounts of prostaglandins in presence of tissue injury and inflammation. Prostaglandins exert their influence on nerve membrane excitability both at the peripheral site and at the spinal dorsal horn. Their key role in peripheral tissue inflammation and central sensitization warrants their incorporation in pain management strategies for children. As the COX2 isoenzyme is the main target for controlling hyperalgesia, nonsteroidal anti-inflammatory drugs (NSAIDs) with high affinity for this enzyme will provide reliable antihyperalgesic effects. The benefits of NSAIDs for postsurgical pain therapy must be balanced against the risk of postoperative bleeding in children in whom any derangement of hemostasis could adversely affect outcome. If contraindications for NSAID use exist, paracetamol is the alternative. Paracetamol has potent antipyretic and analgesic effects, but no anti-inflammatory effect. The rectal route of administration is notoriously unreliable for eliciting an analgesic effect and the oral route is to be preferred. The dosage of paracetamol must take into account the pharmacokinetic properties of the drug in children. The maximum daily dosage should not be exceeded to avoid excessive production of a hepatotoxic metabolite.