{"id":66635,"date":"2021-06-10T10:30:11","date_gmt":"2021-06-10T12:30:11","guid":{"rendered":"https:\/\/www.pasveik.lt\/?p=66635\/sveikatos-ir-medicinos-naujienos"},"modified":"2021-06-10T10:30:13","modified_gmt":"2021-06-10T12:30:13","slug":"vaiku-skausmo-malsinimas-ibuprofenu-2","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/vaiku-skausmo-malsinimas-ibuprofenu-2\/66635\/","title":{"rendered":"Vaik\u0173 skausmo mal\u0161inimas ibuprofenu"},"content":{"rendered":"\n<p>Skausmas&nbsp;\u2013 tai klinikinis rei\u0161kinys, susidedantis i\u0161 \u012fvairi\u0173 komponent\u0173 (jutimini\u0173, fiziologini\u0173, psichologini\u0173, kognityvini\u0173, emocini\u0173, elgesio, dvasini\u0173), padedan\u010di\u0173 suvokti juntam\u0105 skausm\u0105 [1]. Skausmo \u012fvertinimas medicinoje padeda parinkti tinkamiausi\u0105 kovos su juo b\u016bd\u0105, ta\u010diau pediatrijoje neretai tai padaryti sunku d\u0117l su am\u017eiumi susijusio bendravimo barjero. Siekiant kuo geriau \u012fvertinti skausm\u0105, sukurti jo vertinimo metodai. Jie yra pritaikyti \u012fvairaus am\u017eiaus vaikams bei skirtingoms klinikin\u0117ms situacijoms. Tinkamai \u012fvertinus skausm\u0105, turi b\u016bti skiriamas adekvatus farmakologinis ar nefarmakologinis gydymas&nbsp;[2].<\/p>\n\n\n\n<p>Straipsnyje ap\u017evelgiamas \u0161iuo metu pla\u010diai naudojamo vaisto nuo skausmo&nbsp;\u2013 ibuprofeno&nbsp;\u2013 tinkamumas, nepageidaujami rei\u0161kiniai, skyrimo vaikams rekomendacijos ir vaisto indikacijos.<\/p>\n\n\n\n<p><strong>Ibuprofeno veikimas<\/strong><\/p>\n\n\n\n<p>Ibuprofenas&nbsp;\u2013 tai nesteroidinis vaistas nuo u\u017edegimo (NVNU), skirtas lengvam ir vidutinio stiprumo skausmui mal\u0161inti, tinkamas tiek vaikams, tiek suaugusiesiems. Ibuprofenas slopina u\u017edegim\u0105 ir mal\u0161ina skausm\u0105 veikdamas kaip ciklooksigenaz\u0117s 2 (angl.&nbsp;<em>Cyclooxygenase 2&nbsp;\u2013<\/em> COX-2) inhibitorius, tod\u0117l suma\u017e\u0117ja prostaglandin\u0173 i\u0161siskyrimas. Kadangi ibuprofenas n\u0117ra selektyvus COX-2 inhibitorius, \u0161is vaistas taip pat inhibuoja ir ciklooksigenaz\u0119 1 (COX-1). Kadangi vartojant NVNU d\u0117l COX inhibavimo slopinamas prostaglandin\u0173 i\u0161siskyrimas, kyla nepageidaujam\u0173 gastrointestini\u0173 rei\u0161kini\u0173 rizika (pvz., gastritas, pykinimas, v\u0117mimas, gastrointestinis kraujavimas ir kt.). Tyrimuose, kuriuose tirtas ibuprofeno poveikis vir\u0161kinimo sistemai, nustatyta, kad ibuprofenas yra ma\u017eiausiai toksi\u0161kais NVNU grupei priklausantis vaistas ir suaugusiesiems, ir vaikams [3\u20135]. Vertinant ibuprofeno tinkamum\u0105 ir efektyvum\u0105, atlikta daug \u012fvairi\u0173 tyrim\u0173, tarp j\u0173 ir palyginimas tyrimas, kuriame analizuotas pirmojo pasirinkimo vaistas acetaminofenas. Dvigubai aklame, atsitiktini\u0173 im\u010di\u0173 klinikiniame tyrime, \u012f kur\u012f buvo \u012ftraukti 84&nbsp;192 vaikai (nuo 6 m\u0117nesi\u0173 iki 12 met\u0173), jau daugiau kaip prie\u0161 20 met\u0173 \u012frodytas ibuprofeno naudojimo vaikams tinkamumas, o tarp vartojusi\u0173j\u0173 ibuprofen\u0105 arba acetaminofen\u0105 nepageidaujam\u0173 rei\u0161kini\u0173 da\u017enis reik\u0161mingai nesiskyr\u0117 [6].<\/p>\n\n\n\n<p><strong>Ibuprofeno naudojimas klinikin\u0117je praktikoje<\/strong><\/p>\n\n\n\n<p>Siekiant numal\u0161inti \u016bmin\u012f skausm\u0105, pirmiausia reikalingas tinkamas skausmo \u012fvertinimas, skirstant j\u012f \u012f lengv\u0105, vidutin\u012f ir stipr\u0173. Lengvam skausmui mal\u0161inti da\u017eniausiai pasirenkamas acetaminofenas ar&nbsp;\/&nbsp;ir NVNU (da\u017eniausiai ibuprofenas), vidutiniam skausmui slopinti gali b\u016bti pasirenkami silpnesni narkotiniai (opioidiniai) preparatai (galima derinti su acetaminofenu ar NVNU), o stipriam skausmui gydyti tinkami narkotiniai medikamentai (pvz., morfinas), papildomai pagal poreik\u012f pridedant steroidus, antikonvulsantus, anestetikus ir kt. [1].<\/p>\n\n\n\n<p>Nors vidutiniam skausmui gydyti gali b\u016bti skiriami silpnesni opioidiniai medikamentai, tokie kaip kodeinas ir tramadolis, j\u0173 naudojimas ma\u017e\u0117ja, nes \u012fvairios mokslin\u0117s organizacijos nepalaiko j\u0173 vartojimo. Be to, nustatytas acetaminofeno ir kodeino derinio ry\u0161ys su tokiais nepageidaujamais rei\u0161kiniais kaip kv\u0117pavimo slopinimas, sedacija, pykinimas ir v\u0117mimas, viduri\u0173 u\u017ekiet\u0117jimas [16\u201317]. Negana to, <em>greit\u0173 metabolizuotoj\u0173<\/em> grupei priskiriamiems vaikams did\u0117ja su kv\u0117pavimo takais susijusi\u0173 komplikacij\u0173 rizika, toki\u0173 kaip miego apn\u0117ja (steb\u0117ti keli obstrukcin\u0117s miego apn\u0117jos atvejai vaikams po tonzilektomijos) [18]. Siekiant i\u0161vengti opioidini\u0173 medikament\u0173 vartojimo, vis da\u017eniau vidutiniam skausmui slopinti pasirenkamas gydymas acetaminofeno ir ibuprofeno deriniu, taip pat \u0161i\u0173 vaist\u0173 derinys gali b\u016bti skiriamas siekiant suma\u017einti opioidini\u0173 medikament\u0173 poreik\u012f mal\u0161inant stipr\u0173 skausm\u0105 [19\u201320].<\/p>\n\n\n\n<p>Ibuprofeno absorbcija esant tu\u0161\u010diam skrand\u017eiui yra greita. Vaisto kraujo plazmoje koncentracijos pikas pasiekiamas po 45\u201360&nbsp;min. Vaist\u0105 vartojant po valgio, koncentracijos pikas paciekiamas per 90\u2013180&nbsp;min. Ibuprofeno skilimo pusperiodis yra 2\u20134&nbsp;val., net 90\u201399&nbsp;proc. vaisto jungiasi su baltymais. Did\u017eioji dalis vaisto metabolizuojama kepenyse per P450 citochromo ferment\u0173 kompleks\u0105 ir pa\u0161alinama per inkstus per 24\u2013val. po paskutin\u0117s vaisto doz\u0117s vartojimo [3, 21\u201322].<\/p>\n\n\n\n<p><strong>Pagrindin\u0117s ibuprofeno skyrimo indikacijos<\/strong><\/p>\n\n\n\n<p>Ibuprofenas efektyviai mal\u0161ina \u016bmin\u012f skausm\u0105. I\u0161skiriamos kelios klinikin\u0117s situacijos, kuri\u0173 metu ibuprofeno efektyvumas yra patvirtintas mokslo (apibendrinimas pateikiamas 1&nbsp;lentel\u0117je).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Gerkl\u0117s skausmas. Tyrimais \u012frodytas ibuprofeno efektyvumas mal\u0161inant vaik\u0173 gerkl\u0117s skausm\u0105. Tyrimuose, kuriuose vertintos placeb\u0105 ir acetaminofen\u0105 vartojusios tiriam\u0173j\u0173 grup\u0117s, ibuprofeno efektyvumas prilygo acetaminofenui ir abu vaistai buvo efektyv\u016bs, palyginti su placebu [23\u201324]. Ibuprofeno ir acetaminofeno deriniu nerekomenduojama mal\u0161inti gerkl\u0117s skausmo. Esant p\u016blingam procesui ir vietiniam adenitui, ibuprofenas yra tinkamesnis pasirinkimas d\u0117l antiu\u017edegiminio poveikio [25].<\/li><li>Aus\u0173 skausmas. Palyginti su acetaminofenu, ibuprofenas labai pana\u0161iai mal\u0161ino vidurinio otito sukelt\u0105 aus\u0173 skausm\u0105&nbsp;[26]. Sistemin\u0117je ap\u017evalgoje, \u012fvertinus acetaminofeno ir NVNU (tarp j\u0173 ir ibuprofeno) efektyvum\u0105 gydant vidurin\u012f otit\u0105, steb\u0117tas vienodas skausm\u0105 mal\u0161inantis poveikis po 24 ir 48&nbsp;val. gydymo, be to, gydymas deriniu nebuvo efektyvesnis u\u017e monoterapij\u0105 [27].<\/li><li>Dant\u0173 skausmas. Ibuprofenas rekomenduojamas vaik\u0173 odontogenin\u0117s kilm\u0117s skausmui slopinti po odontologini\u0173 proced\u016br\u0173 ar esant dant\u0173 \u0117duoniui [28]. Kai kuriuose \u0161altiniuose teigiama, kad ibuprofenas geriau slopina dant\u0173 skausm\u0105 nei acetaminofenas. Vaik\u0173 nuo 5 iki 12 met\u0173 dant\u0173 skausmo mal\u0161inimo tyrime steb\u0117tas ibuprofeno efektyvumas, prilygstantis acetaminofeno ir kodeino deriniui [29].<\/li><li>Galvos skausmas. Keliuose placebu kontroliuojamuose tyrimuose steb\u0117tas ibuprofeno efektyvumas mal\u0161inant galvos skausm\u0105 per 2&nbsp;val. [22, 31]. \u012evertinus ibuprofeno (10&nbsp;mg\/kg) ir acetaminofeno (15&nbsp;mg\/kg) efektyvum\u0105, abiej\u0173 vaist\u0173 efektyvumas per 2&nbsp;val. buvo dvigubai geresnis nei placebo. Literat\u016bros duomenys prie\u0161taringai vertina, ar ibuprofenas yra efektyvesnis u\u017e acetaminofen\u0105 mal\u0161inant galvos skausm\u0105, ta\u010diau ibuprofenas galimai \u0161io tipo skausm\u0105 mal\u0161ina grei\u010diau [32\u201334].<\/li><li>Potrauminis raumen\u0173 ir kaul\u0173 sistemos skausmas. Ibuprofenas yra tinkamas pasirinkimas vaik\u0173 potrauminiam skausmui slopinti, o vienoje sistemin\u0117je ap\u017evalgoje net vertinamas kaip prilygstantis efektyvumu acetaminofeno ir kodeino deriniui ar net morfinui, ta\u010diau sukeliantis ma\u017eiau nepageidaujam\u0173 rei\u0161kini\u0173 [35\u201336]. Vertinant 6\u201317 met\u0173 vaik\u0173 skausm\u0105 po traum\u0173 (tarp j\u0173 54&nbsp;proc. kaul\u0173 l\u016b\u017ei\u0173), steb\u0117tas geresnis ibuprofeno (10&nbsp;mg\/kg) efektyvumas, palyginti su acetaminofenu (15&nbsp;mg\/kg) ir kodeinu (1&nbsp;mg\/kg) [37]. 2014 metais paskelbtame atsitiktini\u0173 im\u010di\u0173 tyrime palygintas ibuprofeno ir morfino efektyvumas 134 vaikams slopinant nekomplikuot\u0173 gal\u016bni\u0173 l\u016b\u017ei\u0173 sukelt\u0105 skausm\u0105; remiantis gautais rezultatais, poveikis reik\u0161mingai nesiskyr\u0117 [38].<\/li><\/ul>\n\n\n\n<p><strong>1 lentel\u0117. Ibuprofeno ir acetaminofeno efektyvumo gydant skausm\u0105 palyginimas<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>&nbsp;<\/td><td><strong>Ibuprofenas<\/strong><\/td><td><strong>Acetaminofenas<\/strong><\/td><\/tr><tr><td>Gerkl\u0117s skausmas<\/td><td>=<\/td><td>=<\/td><\/tr><tr><td>Aus\u0173 skausmas<\/td><td>=<\/td><td>=<\/td><\/tr><tr><td>Dant\u0173 skausmas<\/td><td>&gt;&nbsp;<\/td><td>&lt;&nbsp;<\/td><\/tr><tr><td>Galvos skausmas<\/td><td>= arba &gt;<\/td><td>&lt; arba =<\/td><\/tr><tr><td>Kaul\u0173 ir raumen\u0173 skausmas<\/td><td>&gt;&nbsp;<\/td><td>&lt;&nbsp;<\/td><\/tr><tr><td>Pooperacinis skausmas (po nedidel\u0117s apimties chirurgini\u0173 intervencij\u0173)<\/td><td>= arba &gt;<\/td><td>&lt; arba =<\/td><\/tr><tr><td>Skausmas po adenoidektomijos ar tonzilektomijos<\/td><td>&gt;&nbsp; (\u012fvertinti kraujavimo rizik\u0105)<\/td><td>&lt;&nbsp;<\/td><\/tr><\/tbody><\/table><figcaption><em>= \u2013 efektyvumas pana\u0161us, > \u2013 efektyvumas geresnis, &lt; \u2013 efektyvumas ma\u017eesnis.<\/em><\/figcaption><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Apibendrinimas<\/strong><\/p>\n\n\n\n<p>\u016aminis skausmas yra da\u017ena problema pediatrijoje, be to, skausm\u0105 naujagimiams ir k\u016bdikiams \u012fvertinti n\u0117ra lengva. Vaikai neretai ken\u010dia d\u0117l nepakankamo skausmo \u012fvertinimo ir jo slopinimo. Da\u017eniausiai vaikus vargina gerkl\u0117s, aus\u0173, dant\u0173, galvos, potrauminis ar pooperacinis skausmas. Ibuprofenas yra vienas labiausiai i\u0161tirt\u0173, efekyvi\u0173 ir gerai vaik\u0173 toleruojam\u0173 vaist\u0173 nuo \u016bminio skausmo. Kuriais atvejais efektyvumu jis lenkia gydyma acetaminofenu ar acetaminofeno ir kodeino deriniu, o tai padeda suma\u017einti opioidini\u0173 analgetik\u0173 poreik\u012f.<\/p>\n\n\n\n<p><strong>Aist\u0117 Aleknait\u0117<\/strong><br>Vilnius universiteto ligonin\u0117s <em>Santaros<\/em> klinikos<\/p>\n\n\n\n<p><strong>Literat\u016bra<\/strong><\/p>\n\n\n\n<p>1. Il Dolore nel bambino. Ministero della Salute, 2010. Available at: http:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_1256_allegato.pdf.<br>2. Manworren RC, Stinson J. Pediatric pain measurement, assessment, and evaluation. Semin Pediatr Neurol. 2016;23:189\u2013200.<br>3. Rainsford KD. Ibuprofen: pharmacology, efficacy and safety. Inflammopharmacology. 2009;17:275\u2013342.<br>4. Southey ER, Soares-Weiser K, Kleijnen J. Systematic review and meta-analysis of the clinical safety and tolerability of ibuprofen compared with paracetamol in paediatric pain and fever. Curr Med Res Opin. 2009; 25:2207\u20132222.<br>5. deMartinoM, Chiarugi A, Boner A, et al.Working towards an appropriate use of ibuprofen in children: an evidence-based appraisal. Drugs. 2017;77:1295\u20131311.<br>6. Lesko SM, Mitchell AA. An assessment of the safety of pediatric ibuprofen. A practitioner-based randomized clinical trial. JAMA. 1995;273:929\u2013933.<br>7. Schaller S, Kaplan BS. Acute nonoliguric renal failure in children associatedwith nonsteroidal antiinflammatory agents. Pediatr Emerg Care. 1998;14:416\u2013418.<br>8. Flores-P\u00e9rez C, Ch\u00e1vez-Pacheco JL, Ram\u00edrez-Mendiola B, et al. A reliable method of liquid chromatography for the quantification of acetaminophen and identification of its toxic metabolite N-acetyl-p-benzoquinoneimine for application in pediatric studies. Biomed Chromatogr. 2011;25:760\u2013766.<br>9. Leroy S, Mosca A, Landre-Peigne C, et al. Ibuprofen in childhood: evidence-based review of efficacy and safety. Arch Pediatr. 2007;14:477\u2013484.<br>10. Misurac JM, Knoderer CA, Leiser JD, et al. Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr. 2013;162:1153\u20131159.<br>11. Balestracci A, Ezquer M, Elmo ME, et al. Ibuprofen-associated acute kidney injury in dehydrated children with acute gastroenteritis. Pediatr Nephrol. 2015;30:1873\u20131878.<br>12. Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017;25:1\u20139.<br>13. Zerr DM, Alexander ER, Duchin JS, et al. A case-control study of necrotizing fasciitis during primary varicella. Pediatrics. 1999;103:783\u2013790.<br>14. Lesko SM, O&#8217;Brien KL, Schwartz B, et al. Invasive group A streptococcal infection and nonsteroidal antiinflammatory drug use among children with primary varicella. Pediatrics. 2001;107:1108\u20131115.<br>15. Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunol 2001; 87:177.<br>16. B\u00e1rzaga Arencibia Z, Choonara I. Balancing the risks and benefits of the use of over-the-counter pain medications in children. Drug Saf. 2012;35:1119\u20131125.<br>17. Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs. 2001;3:817\u2013858.<br>18. Andrzejowski P, Carroll W. Codeine in paediatrics: pharmacology, prescribing and controversies. Arch Dis Child Educ Pract Ed. 2016;101:148\u2013151.<br>19. Smith C, Goldman RD. Alternating acetaminophen and ibuprofen for pain in children. Can Fam Physician.2012;58:645\u2013647.<br>20. Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother. 2010;44:489\u2013506.<br>21. Rainsford KD, Bjarnason I. NSAIDs: take with food or after fasting? J Pharm Pharmacol. 2012;64:465\u2013469.<br>22. Bushra R, Aslam N. An overview of clinical pharmacology of ibuprofen. Oman Med J.2010;25:155\u20131661.<br>23. Bertin L, Pons G, d&#8217;Athis P, et al. Randomized, double blind, multicenter, controlled trial of ibuprofen versus acetaminophen (paracetamol) and placebo for treatment of symptoms of tonsillitis and pharyngitis in children. JPediatr. 1991;119:811\u2013814.<br>24. Schlachtel BP, Thoden WR. A placebo-controlled model for assaying systemic analgesics in children. Clin Pharmacol Ther.1993;53:593\u2013601.<br>25. Chiappini E, Principi N, Mansi N, et al. Management of acute pharyngitis in children: summary of the Italian National Institute of Health Guidelines. Clin Ther. 2012;34:1442\u20131458.<br>26. Bertin L, Pons G, d&#8217;Athis P, et al. A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol. 1996;10:387\u2013392.<br>27. Sjoukes A, Venekamp RP, van de Pol AC, et al. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children. Cochrane Database Syst Rev . 2016;12:CD011534.<br>28. Ashley PF, Parekh S, Moles DR, et al. Preoperative analgesics for additional pain relief in children and adolescents having dental treatment. Cochrane Database Syst Rev. 2016:CD008392.<br>29. Moore PA, Acs G, Hargreaves JA. Postextraction pain relief in children: a clinical trial of liquid analgesics. Int J Clin Pharmacol Ther Toxicol. 1985;23:573\u2013577.<br>30. Bradley RL, Ellis PE, Thomas P, et al. A randomized clinical trial comparing the efficacy of ibuprofen and paracetamol in the control of orthodontic pain. Am J Orthod Dentofacial Orthop. 2007;132:511\u2013517.<br>31. Bailey B, Trottier ED. Managing pediatric pain in the emergency department. Paediatr Drugs. 2016;18:287\u2013301.<br>32. H\u00e4m\u00e4l\u00e4inen ML, Hoppu K, Valkeila E, et al. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double-blind, randomized, placebo-controlled, crossover study. Neurology. 1997;48:103\u2013107.<br>33. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev. 2016;4:CD005220.<br>34. Jeric M, Surjan N, Jelicic Kadic A, et al. Treatment of acute migraine attacks in children with analgesics on the World Health Organization Essential Medicines List: a systematic review and GRADE evidence synthesis. Cephalalgia. 2017:333102417736902.<br>35. Korownyk C, Young J, Michael Allan G. Optimal pain relief for pediatric MSK injury. Can Fam Physician. 2015;61:e276.<br>36. Le May S, Ali S, Khadra C, et al. Pain management of pediatric musculoskeletal injury in the emergency department: a systematic review. Pain Res Manag. 2016;2016:4809394.<br>37. Clark E, Plint AC, Correll R, et al. A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics. 2007;119:460\u2013467.<br>38. Poonai N, Bhullar G, Lin K, et al. Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial. CMAJ. 2014;186:1358\u20131363.<br>39. Brasher C, Gafsous B, Dugue S, et al. Postoperative pain management in children and infants: an update. Paediatr Drugs. 2014;16:129\u2013140.<br>40. Kokki H. Nonsteroidal anti-inflammatory drugs for postoperative pain: a focus on children. Paediatr Drugs. 2003;5:103\u2013123.<br>41. Moss JR, Watcha MF, Bendel LP, et al. A multicenter, randomized, double-blind placebo-controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy. Paediatr Anaesth. 2014;24:483\u2013489.<br>42. Kelly LE, Sommer DD, Ramakrishna J, et al. Morphine or ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015;135:307\u2013313.<br>43. Mattos JL, Robison JG, Greenberg J, et al. Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol. 2014;78:1671\u20131676.<br>44. D&#8217;Souza JN, Schmidt RJ, Xie L, et al. Postoperative nonsteroidal anti-inflammatory drugs and risk of bleeding in pediatric intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2015;79:1472\u20131476.<br>45. Liu C, Ulualp SO. Outcomes of an alternating ibuprofen and acetaminophen regimen for pain relief after tonsillectomy in children. Ann Otol Rhinol Laryngol. 2015;124:777\u2013781.<br>46. Bedwell JR, Pierce M, Levy M, et al. Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency department utilization.OtolaryngolHead Neck Surg. 2014;151: 963\u2013966.<br>47. Postoperative ibuprofen and the risk of bleeding after tonsillectomy with or without adenoidectomy. Available at: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01605903.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Skausmas&nbsp;\u2013 tai klinikinis rei\u0161kinys, susidedantis i\u0161 \u012fvairi\u0173 komponent\u0173 (jutimini\u0173, fiziologini\u0173, psichologini\u0173, kognityvini\u0173, emocini\u0173, elgesio, dvasini\u0173), padedan\u010di\u0173 suvokti juntam\u0105 skausm\u0105 [1]. Skausmo \u012fvertinimas medicinoje padeda parinkti tinkamiausi\u0105 kovos su juo b\u016bd\u0105, ta\u010diau pediatrijoje neretai tai padaryti sunku d\u0117l su am\u017eiumi susijusio bendravimo barjero. Siekiant kuo geriau \u012fvertinti skausm\u0105, sukurti jo vertinimo metodai. Jie yra pritaikyti \u012fvairaus&#8230;<\/p>\n","protected":false},"author":35,"featured_media":66636,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27330],"tags":[],"site":[27309],"post_item_type":[27345],"class_list":["post-66635","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vaiku-ligos","site-imunitetas-lt"],"acf":{"post_sites":[27309]},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/66635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/35"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=66635"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/66635\/revisions"}],"acf:term":[{"embeddable":true,"taxonomy":"site","href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site\/27309"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/66636"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=66635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=66635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=66635"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=66635"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=66635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}