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Rectally administered diclofenac (Voltaren) reduces vomiting compared with opioid (morphine) after strabismus surgery
1Department of Anaesthesia, Skaraborg Hospital, S-541 85 Skövde, Sweden.
Insights
Rectal diclofenac effectively manages pain and reduces postoperative nausea and vomiting (PONV) in children after strabismus surgery, offering a better alternative to intravenous morphine. This study highlights diclofenac
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Complications
Background:
- Post-strabismus surgery in children commonly involves nausea, vomiting, and pain.
- Rectal diclofenac's efficacy for pain and nausea post-strabismus surgery in pediatric patients is under-reported.
- This study compares rectally administered diclofenac with intravenous morphine for managing these complications.
Purpose of the Study:
- To evaluate the analgesic effects of rectally administered diclofenac versus intravenous morphine.
- To assess the anti-emetic properties of rectally administered diclofenac compared to intravenous morphine.
- To determine the safety and efficacy of rectal diclofenac in pediatric strabismus surgery.
Main Methods:
- A randomized study involving 50 children (4-16 years) undergoing strabismus surgery.
- Participants received either rectal diclofenac (1 mg/kg) or intravenous morphine (0.05 mg/kg) perioperatively.
- Postoperative pain, nausea, and vomiting (PONV) were assessed using validated scales.
Main Results:
- The incidence of PONV was significantly lower in the diclofenac group (12%) compared to the morphine group (72%).
- No significant difference in pain scores was observed between the two groups.
- The morphine group experienced longer recovery times and higher analgesic requirements.
Conclusions:
- Rectal diclofenac is an effective analgesic for strabismus surgery in children.
- Rectal diclofenac demonstrates superior anti-emetic properties compared to intravenous morphine.
- No serious adverse events were reported with rectal diclofenac administration.
Background:
Nausea, vomiting and pain are common complications after strabismus surgery in children. Diclofenac, a non-steroid anti-inflammatory drug, is widely used to treat acute and chronic pain but there are few reports of its use given rectally in children undergoing strabismus surgery. This open randomised study was designed to investigate the analgesic and anti-emetic properties of rectally administered diclofenac compared with opioid (morphine) given i.v. in connection with strabismus surgery in children.
Methods:
After obtaining approval from the local ethics committee and written informed consent from the parents, 50 ASA class I-II children, 4-16 years of age, were randomised to receive either rectally administered diclofenac (Voltaren) 1 mg/kg or i.v. opioid (morphine) 0.05 mg/kg perioperatively. The children were consecutively operated upon from May 1999 to January 2001. Anaesthesia was induced with fentanyl and propofol and maintained with propofol. Nitrous oxide was omitted. The postoperative pain was assessed after arrival at the post anaesthesia care unit (PACU) by using the validated Wong and Baker scale (FACES) Pain Rating Scale. Postoperative nausea and vomiting (PONV) was assessed by measuring the frequency of vomiting and the degree of nausea.
Results:
In the diclofenac group the incidence of PONV during the first 24 h was 12% (of which one child had severe vomiting). The incidence of PONV was much higher, 72% (P = 0.0000), in the morphine group, where 56% of the children also had severe vomiting. There were no difference in pain score between the two groups. Recovery time at the PACU was longer (P < 0.002) and the postoperative analgesic requirement higher in the morphine group (10 vs. 5 children). No children needed overnight admission to the hospital.
Conclusion:
Diclofenac given rectally is an effective analgesic for this kind of surgery and gives less postoperative nausea than i.v. morphine. No serious adverse events were observed.