The effect of paracetamol or diclofenac administered before operation on postoperative pain and behaviour after adenoidectomy in small children

Abstract

SummaryWe compared the effects of rectally administered diclofenac (12.5 mg) with paracetamol (12s mg) on pre-and postoperative behaviour and the need for supplementary analgesia in 44 children scheduled for adenoidectomy (with or without myringotomy). The study drugs were given in combination with diazepam (0.5 mg.kg-') about 20 min before the children were taken to the operating theatre. On arrival there, the children who had received diclofenac were significantly quieter ( < 0.05), easier to handle ( p < 0.01) and cried less ( p < 0.05) than those in the paracetamol group. During recovery. children in the diclofenac group needed fewer supplementary doses of intravenous pethidine than those receiving paracetamol ( p < 0.001). There were no obvious differences between the groups in intra-operative bleeding (as estimated by the surgeon), or in measured blood loss. No postoperative complications became evident. The pre-operative rectal administration of diclofenac for pain relief after adenotomy is safe and effective. Key wordsAnalgesics; diclofenac, paracetamol. Anaesthesia; paediatric. Pain; postoperative.The use of nonsteroidal anti-inflammatory drugs (NSAIDs) for supplementation of postoperative pain treatment has gained wide acceptance. Because of their mode of action it is preferable that these drugs are given prophylactically before the synthesis of prostaglandins is initiated by tissue trauma. This method has been shown to provide improved analgesia after superficial surgery when compared to postoperative medication [ 11, although other workers have produced conflicting results [2, 31.Paracetamol is a widely used analgesic in small children. It lacks many of the serious side effects of opioids and is only slightly sedating. Diclofenac is a well established NSAID which is known to have useful postoperative analgesic proporties in adults and which is now available for use in small children.The aim of the study was to compare, in small children, the behavioural and analgesic effects of rectally administered diclofenac (12.5 mg) with paracetamol (125 mg). MethodsThe study was approved by the Ethics Committee of Tampere University Hospital and written informed parental consent was obtained. Forty-four children, ASA I, weighing 11.0-14.0 kg and scheduled for adenoidectomy (with or without myringotomy) entered the study. Patients were not studied for the following reasons: suspected or manifest bleeding disturbances, allergy to aspirin-like drugs, atopy, bronchial asthma, or a history of serious side effects due to aspirin-like drugs.Before operation the children were allocated randomly to receive, in a double-blind manner, a rectal suppository of either paracetamol 125 mg (Panadol, Winthorp Ltd) or diclofenac 12.5 mg (Voltaren, Ciba Geigy AG). Both were given with rectal diazepam (0.5 mg.kg-') (Apozepam, Dumex AL) on the ward 20min before leaving for the operating theatre. In all cases EMLA cream (Astra Ltd) was applied beforehand to sites suitable for venous cannulation. On the advice of parents, comforters, d...

Controversies in the Perioperative Use of Nonsterodial Antiinflammatory Drugs

“…In a comparative study involving oral diclofenac (12.5 mg) and acetaminophen (125 mg), the diclofenactreated children demonstrated decreased preoperative restlessness, crying in response to handling, and a reduced postoperative meperidine requirement (36). In a placebo-controlled study involving children undergoing placement of ear tubes, the preoperative administration of oral ketorolac (1 mg/kg in cherry syrup) resulted in lower pain scores and a decreased requirement for supplemental analgesics in the postoperative period compared to acetaminophen (10 mg/kg) (37).…”

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

“…[24] Our study finding were in contrast with finding of Baer and his colleagues who demonstrated that children receiving preoperative rectal diclofenac sodium needed fewer supplementary doses of postoperative pethidine compared to those who received pre-operative rectal paracetamol. [25] Paracetamol is an effective antipyretic at plasma concentration of 0.066-0.130 mmol/L. [17,26,27] In our study, body temperature of children also had decreased significantly in Gr.…”

Role of intravenous paracetamol as an adjunct to epidural analgesia in immediate postoperative period in abdominal cancer surgeries

“…Literature review showed worldwide up to 70% of patients receive ineffective, inadequate or delayed postoperative pain relief. 5 In postoperative period, multimodal analgesia strategy is used to obtain maximum pain relief with minimum side effects. Combination of paracetamol and/or NSAIDS, opioids and local anaesthetics through regional anaesthesia are component of multimodal analgesia.…”