The analgesic effects of rectal diclofenac versus rectal paracetamol following caudal-bupivacaine for pediatric day-case inguinal herniotomies: a randomized controlled prospective trial

Nnaji, Chimaobi Tim; Onajin-Obembe, Bisola; Ebirim, Longinus N.

doi:10.1016/j.jpedsurg.2017.05.001

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…Nnaji et al 17 carried out a study on 90 children undergoing inguinal herniotomy to compare the efficacy of postoperative analgesia of caudal-bupivacaine and rectal diclofenac with caudal-bupivacaine and rectalparacetamol. They concluded that caudal-bupivacaine and rectal-diclofenac combination offers prolonged postoperative analgesia and decreased pain scores compared to caudal-bupivacaine and rectal-paracetamol combination or caudal-bupivacaine alone.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia After Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine

Sabih¹,

Zahir

Zulfiqar

et al. 2023

Ann Pak Inst Med Sci

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Objective: To compare the efficacy of intravenous paracetamol and rectal diclofenac combination with caudal block using 1ml/kg of 0.25% bupivacaine in the management of post-operative pain following paediatric inguinal herniotomy. Methodology: This quasi-experimental study was conducted at the Department of Anesthesia, Holy Family Hospital, Rawalpindi, from February 2020 to August 2020. A total of 342 children aged 2-12 years requiring inguinal herniotomy were enrolled after satisfying the inclusion and exclusion criteria. Computer-generated random numbers were used to split the patients into two groups. Group A received intravenous paracetamol (30 mg/kg) and rectal diclofenac (1mg/kg). Group B received a caudal block using 1ml/kg of 0.25% Bupivacaine. Pain was assessed postoperatively in the PACU by modified Objective Pain Scale (OPS) every 15 minutes for the 1st hour and hourly up till 8 hours. Effective analgesia was defined as a modified OPS score of ≤ 3 for upto 8 hours after shifting to PACU. If at any time, the score was >3 and the patient required a rescue analgesic, effective anaglesia was not achieved. Results: Effective analgesia was achieved in 82.46% of the patients (n=141) in Group-A versus 87.13% patients (n=149) in Group-B (p-value: 0.23). Conclusion: There is no significant difference in the efficacy of analgesia in paracetamol/diclofenac combination group compared with caudal bupivacaine group.

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Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia After Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine

Sabih¹,

Zahir

Zulfiqar

et al. 2023

Ann Pak Inst Med Sci

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“…NSAIDs and paracetamol were compared in 2 previous studies for children undergoing open hernia repair surgery and in 1 study for children undergoing adenoidectomy, in which the drugs were orally or rectally and administered preoperatively. [24][25][26] In another study that used orally-administered drugs, the mean pain score on arrival at the PACU indicated a need for immediate multiple opioid treatments, even under the most effective nonopioid treatment regimens. 25 For children undergoing adenoidectomy for which the anesthetic duration was approximately 30 minutes, the time to the first dose of opioid was not significantly different compared with placebo, and the opioid-sparing effect of rectal acetaminophen and ibuprofen combination was only 28%, which was not different from that of acetaminophen alone (19%) and NSAID alone (27%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial

Lee

Park

et al. 2020

Anesthesia &Amp; Analgesia

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BACKGROUND: Extensive efforts have been made toward reducing postoperative opioid use in children. In this study, we assessed whether propacetamol, or a nonsteroidal anti-inflammatory drug (NSAID), or their combination could effectively reduce opioid use in children after laparoscopic inguinal hernia repair. METHODS: This randomized, double-blind clinical trial included 159 children aged 6 months to 6 years. Children were allocated into 1 of the following 3 groups: group I was treated with 10 mg·kg−1 ibuprofen, group P was treated with 30 mg·kg−1 propacetamol, and group I + P was treated with both drugs in their respective concentrations. If the face–legs–activity–crying–consolability (FLACC) score was ≥4 during the postanesthesia care unit stay, 1.0 µg·kg−1 fentanyl was administered as a rescue analgesic. The number of patients who received rescue fentanyl in the postanesthesia care unit was defined as the primary outcome; this was analyzed using the χ2 test. The secondary outcomes included the FLACC and the parents’ postoperative pain measure (PPPM) scores until the 24-hour postoperative period. RESULTS: Among the 144 enrolled patients, 28.6% in group I, 66.7% in group P, and 12.8% in group I + P received rescue fentanyl in the postanesthesia care unit (P < .001). The highest FLACC score was lower in group I + P than in either group I or P (P = .007 and P < .001, respectively). Group I + P presented significantly lower PPPM scores than group P at 4 and 12 hours postoperative (P = .03 and .01, respectively). CONCLUSIONS: The use of ibuprofen plus propacetamol immediately following laparoscopic hernia repair surgery in children resulted in the reduced use of an opioid drug compared with the use of propacetamol alone.

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Diclofenac for acute postoperative pain in children

Ringsten,

Kredo,

Ebrahim

et al. 2023

Cochrane Database of Systematic Reviews

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The analgesic effects of rectal diclofenac versus rectal paracetamol following caudal-bupivacaine for pediatric day-case inguinal herniotomies: a randomized controlled prospective trial

Cited by 5 publications

References 10 publications

Postoperative Analgesia After Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine

Postoperative Analgesia After Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine

Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial

Diclofenac for acute postoperative pain in children

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