Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: A randomised clinical trial

Abstract

Background:Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect.Objective:To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg) in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements.Study Design:A randomized clinical trial.Methods:After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group) and group C (Conventional group). Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted.Results:We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002). There was no evidence of any increased perioperative bleeding in the diclofenac group.Conclusion:Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.

Perioperative Pain Management in Cleft Lip and Palate Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

“…[20][21][22][23][24]33,34 The utility of acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids for postoperative pain management were also studied. [25][26][27][28]32 Opioid-sparing effects were observed in multiple studies. 22,[24][25][26]28,33 The use of adjuvants (i.e., dexmedetomidine) in anesthetics for nerve blocks resulted in prolonged effective analgesia compared to controls.…”

An Intervention Study on Children’s Healthy Joint Attention Skills Based on a Mixed Instructional Approach of DTT and PRT

“…Reference [ 15 ] divided the instructional content into a 5-stage intervention process and taught imitative behavior to young children with autism. The SCERTS model developed by [ 16 ] refers to seven intervention principles, including an emphasis on the functional use of language and communication in all natural contexts; consideration of the child's emotional regulation and its impact on communication, social interaction, and learning; and the integration of behavioral problems into social communication training programmes and the analysis of behavioral functioning and positive behavioral treatment. Reference [ 17 ] combined DTT orientation and PRT teaching interventions to improve joint attention in children with autism and found that both children showed progress in joint attention after the intervention; [ 18 ] mainly referred to an intervention programme that divided the training process into tabletop and floor time, with the therapist and parents as the intervenor, and analysed behavioral records from the intervention process; [ 19 ] conducted a joint attention intervention with a child with autism.…”

Comparison of preoperative rectal paracetamol with paracetamol - diclofenac combination for postoperative analgesia in pediatric surgeries under general anesthesia

“…There is abundant evidence in the literature proving the effectiveness of diclofenac in postoperative pain management. [ 7 8 9 ] When two different agents targeted at a single pharmacological effect are used in synergism, the said combination allows the reduction in the dose of individual drugs without compromising on the quality of the effect, rendering a wider margin of safety. Thus in our study, we sought to compare the effectiveness of the combination of paracetamol and diclofenac with that of paracetamol alone in combating postoperative pain.…”