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Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients
J Rømsing1, D Ostergaard, D Drozdziewicz
1Department of Pharmaceutics, The Royal Danish School of Pharmacy, Copenhagen. jr@mail.dfh.dk
Insights
Diclofenac and high-dose acetaminophen showed similar pain relief after tonsillectomy. Diclofenac resulted in fewer side effects like nausea and vomiting.
Area of Science:
- Pain Management
- Pediatric Surgery
- Pharmacology
Background:
- Tonsillectomy commonly results in significant postoperative pain.
- Establishing an effective pain management regimen is crucial for pediatric recovery.
- Comparing oral diclofenac and high-dose acetaminophen for post-tonsillectomy pain is essential.
Purpose of the Study:
- To compare the analgesic efficacy of oral diclofenac and high-dose acetaminophen in children post-tonsillectomy.
- To evaluate the incidence of adverse effects, specifically nausea and vomiting, associated with each medication.
- To determine the optimal drug regimen for managing pain after tonsillectomy.
Main Methods:
- A randomized, double-blind study involving 48 children aged 5-15 years undergoing tonsillectomy.
- Participants received either diclofenac (2-3 mg/kg/24h) or acetaminophen (90 mg/kg/24h) for the first three postoperative days.
- Pain was assessed daily via self-report at scheduled intervals; adverse events were recorded.
Main Results:
- Severe pain was reported by a significant percentage of children in both groups (diclofenac: 5-50%; acetaminophen: 12-58%).
- Diclofenac showed statistically significant lower pain scores only at 12-hour intervals on days 1-3 (P<0.05).
- The diclofenac group experienced no nausea/vomiting, compared to 9 children in the acetaminophen group on day 1; nausea/vomiting correlated with pain severity (P<0.05).
Conclusions:
- High-dose acetaminophen (90 mg/kg/24h) and diclofenac demonstrate comparable analgesic efficacy for post-tonsillectomy pain.
- Diclofenac is associated with a significantly lower incidence of nausea and vomiting compared to high-dose acetaminophen.
- Diclofenac may be a preferred option for pain management post-tonsillectomy due to a better side-effect profile.
Background:
In order to establish an effective drug regimen, we compared the analgesic efficacy of oral diclofenac and high-dose acetaminophen on pain after tonsillectomy.
Methods:
In this randomised, double-blind study 48 children, 5 to 15 years of age, following tonsillectomy were assigned to receive either diclofenac 2-3 mg kg(-1) 24 h(-1) (n=24) or acetaminophen 90 mg kg(-1) 24 h(-1) (n=24) for the first three days after surgery. Postoperative pain was assessed by self-report each day before scheduled medication at 7 h, 12 h, 18 h and 23 h.
Results:
The number of children rating severe pain was high in both the diclofenac group, 5-50%, and in the acetaminophen group, 12-58% during the three day study period. Pain scores in the diclofenac group were only significantly lower at 12 h on day 1-3 compared to pain scores in the acetaminophen group (P<0.05). None of the children in the diclofenac group experienced any episodes of nausea/vomiting compared to 9 children in the acetaminophen group on day 1. The incidences of nausea/vomiting increased with pain (P<0.05). None of the 48 children experienced any episodes of bleeding.
Conclusions:
This study indicates that diclofenac was no more effective than high-dose acetaminophen (90 mg vs. 60 mg kg(-1) 24 h(-1)) for analgesia, but resulted in a lower incidence of nausea and vomiting in patients following tonsillectomy.