Preoperative rectal diclofenac versus paracetamol for tonsillectomy: effects on pain and blood loss

Schmidt, Anders; Björkman, Sven; Åkeson, Jonas

doi:10.1034/j.1399-6576.2001.450108.x

Cited by 58 publications

(51 citation statements)

References 22 publications

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“…Morton and O'Brien demonstrated that concurrent administration of diclofenac in children receiving patient-controlled analgesia (PCA) morphine has a highly significant morphinesparing effect, although they failed to demonstrate any extra additive effect of paracetamol [14]. Our finding is similar to those of other investigators who demonstrated a reduction of opioid consumption after diclofenac and paracetamol [13][14][15]. Schmidt and his group reported that pre-operative rectal diclofenac offers no advantage over paracetamol with respect to pain score and the postoperative pethidine consumption in patients undergoing tonsillectomy [15].…”

Section: Discussionsupporting

confidence: 81%

“…Our finding is similar to those of other investigators who demonstrated a reduction of opioid consumption after diclofenac and paracetamol [13][14][15]. Schmidt and his group reported that pre-operative rectal diclofenac offers no advantage over paracetamol with respect to pain score and the postoperative pethidine consumption in patients undergoing tonsillectomy [15]. Similarly, Rømsing and his colleagues demonstrated that diclofenac was no more effective than high-dose paracetamol for analgesia in patients following tonsillectomy [16].…”

Section: Discussionsupporting

confidence: 81%

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Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Riad

Moussa

2007

Anaesthesia

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SummaryBoth rectal diclofenac and paracetamol are commonly used to treat acute postoperative pain in children but combining them to improve the quality of analgesia is controversial. This study aimed to detect whether the pre-operative combined administration of rectal diclofenac and paracetamol is superior to either drug alone. One hundred and eight patients were randomly assigned to receive either rectal diclofenac 1 mg.kg )1 or paracetamol 40 mg.kg )1 or their combination 1 h prior to surgery. In the first 24 h postoperatively, pain was assessed using the Wong and Baker Pain Scale. If the patients experienced a pain score of 2 or more, morphine was given. The total dose of morphine and number of doses required were recorded. Children who received the rectal diclofenac-paracetamol combination experienced a lower pain scale and a decreased need for morphine compared with children receiving each drug alone.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 81%

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Riad

Moussa

2007

Anaesthesia

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“…22 Interestingly, in this study a greater estimated intraoperative blood loss and increased loss of haemoglobin until 24 h was also observed in the conventional NSAID group. The reason for this may well be the reduced production of the coagulation activator thromboxane B 2 , which is biosynthesized by COX-1.…”

Section: Discussionmentioning

confidence: 55%

Effect of Rofecoxib on Platelet Aggregation and Blood Loss in Gynaecological and Breast Surgery Compared With Diclofenac

&NA;

2005

Survey of Anesthesiology

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Background. Non-selective cyclooxygenase (COX) inhibitors or non-steroidal antiin¯ammatory drugs (NSAIDs) are frequently omitted for perioperative pain relief because of potential side-effects. COX-2-selective inhibitors may have a more favourable side-effect pro®le. This study tested the hypothesis that the COX-2-selective inhibitor rofecoxib has less in¯uence on platelet function than the NSAID diclofenac in gynaecological surgery. In addition, analgesic ef®cacy and side-effects of the two drugs were compared.

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“…Findings were in accordance with finding of Schmidt and his group who reported that preoperative rectal diclofenac offers no advantage over paracetamol with respect to pain score and the postoperative pethidine consumption in patients undergoing tonsillectomy. [21] Similarly, Rømsing and his colleagues demonstrated that diclofenac was no more effective than high-dose paracetamol for analgesia inpatients following tonsillectomy [22] Viitanen et al demonstrated that the total morphine used was significantly less in groups receiving paracetamol, ibuprofen or their combination compared to those receiving placebo for paediatric Section: Anaesthesia adenoidectomy. [23] Morton and O'Brien demonstrated that concurrent administration of diclofenac sodium in children receiving patientcontrolled analgesia(PCA) morphine has a highly significant morphine sparing Effect.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries

Iqbal¹,

Mujoo²,

Saleem³

et al. 2016

AIMDR

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Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using "Modified Steward Coma Scale"at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group-P40 was (646±9.94) min Group-D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.

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Preoperative rectal diclofenac versus paracetamol for tonsillectomy: effects on pain and blood loss

Abstract: Preoperative rectal diclofenac offers no advantage over paracetamol with respect to postoperative analgesia in tonsillectomy patients but increases intraoperative blood loss.

Cited by 58 publications

References 22 publications

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Pre‐operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair

Effect of Rofecoxib on Platelet Aggregation and Blood Loss in Gynaecological and Breast Surgery Compared With Diclofenac

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries

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