Intranasal diclofenac sodium, ibuprofen and paracetamol for pain relief after pediatric tonsillectomy

Postoperative pain following pediatric tonsillectomy remains a significant clinical challenge. Concerns about the efficacy and safety of current analgesics have prompted interest in intranasal (IN) delivery of nonsteroidal anti-inflammatory drugs (NSAIDs) as a non-invasive, effective alternative with minimal side effects.

In this prospective, randomized study, we evaluated the analgesic efficacy and safety of IN diclofenac sodium, IN ibuprofen, and IN paracetamol, compared to intravenous (IV) paracetamol, in children aged 2-14 years undergoing tonsillectomy. Sixty patients were randomized into four equal groups. Postoperative pain was assessed using the CHEOPS, VAS, and Wong-Baker modified VAS scores at multiple time points up to 12 h post-surgery. Data were analyzed using the Kruskal-Wallis and Dunn's tests.

At 15 min postoperatively, IN diclofenac sodium and IN ibuprofen resulted in significantly lower pain scores compared to IV paracetamol (p < 0.05). However, this difference was not sustained at later time points. Across most other intervals, pain scores in the IN NSAID groups were numerically lower, but these differences did not reach statistical significance. IN paracetamol was less effective than IV paracetamol at several time points. No serious adverse events, including bleeding, were observed.

IN diclofenac sodium and IN ibuprofen provided a transient reduction in early postoperative pain after pediatric tonsillectomy, with significantly lower pain scores at 15 min compared to IV paracetamol. At subsequent time points, the analgesic efficacy of IN NSAIDs was similar to that of IV paracetamol. The clinical relevance of this short-term benefit remains uncertain, and larger studies with additional outcome measures are warranted.