Postoperative pain relief in pediatric surgery patients: Effect of intravenous paracetamol in comparison with diclofenac suppository

Abstract

Background: Pain is a major problem regarding quality of life in children undergoing surgicaloperation.Pain assessment is the most important and critical component of pain management. Oral andrectal paracetamol formulations are associated with a slower onset of action and more variableanalgesic activity than IV acetaminophen, making them less useful in preoperative and acute caresettings.

Objective: To find out the effect of intravenous paracetamol in releiving postoperative pain in pediatricpatients.

Settings and study design: This randomized clinical trial study was conducted in theAnaesthesiology department of Sir Salimullah Medical College Mitford Hospital,Dhaka fromFebruary' 2014 to August' 2014. A total of 100 cases were taken, they were randomly divided into twogroups in which one group received intravenous paracetamol and another group received diclofenacsuppository for the same operation performed on them, age of the children were between 4-12 years, andall were ASA grade I. Pain relief was assessed with VAS score from 30 minutes after surgery up to 6hours with regular follow up and comparison made between the two groups.

Results: In this study, comparisons by mean visual analog scale between intravenous paracetamolwith diclofenac suppository groups were done. VAS score showed both analgesic reduces pain, butdiclofenac suppository was found better post operative pain reliever than intravenous paracetamolwithin observed 30 min to 2 hours. However observed after 6 hours, diclofenac suppository group issignificantly better than intravenous paracetamol group in relieving post operative pain by measuringVAS.

Conclusion: Our study showed that diclofenac suppository is more effective than IV paracetamol inrelieving postoperative pain. However paracetamol is definitely a viable alternative to the NSA IDs,especially because of the lower incidence of adverse effects, and should be the preferred choice inhigh-risk patients. It may be appropriate to combine paracetamol with NSAIDs,but future studies arerequired especially after major surgery.

JBSA 2022; 35 (2) : 37-42