Intravenous Ibuprofen Versus Diclofenac Suppository for Perioperative Pain Control in Pediatric Tonsillectomy with or without Adenoidectomy: A Randomized Controlled Trial

Kareem Nagy Abbass; Reham Hussein Saleh; Ahmed Lotfy; Ghada Mohamed Omar; Heba Bakr

doi:10.18502/aacc.v12i3.21317

Kareem Nagy Abbass Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
Reham Hussein Saleh Saleh of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
Ahmed Lotfy Saleh of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
Ghada Mohamed Omar Saleh of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
Heba Bakr Saleh of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.

DOI: https://doi.org/10.18502/aacc.v12i3.21317

Keywords: Diclofenac suppository; Intravenous ibuprofen; Pain control; Paracetamol; Tonsillectomy

Abstract

Background: This study aimed to compare the combination of intravenous ibuprofen and intravenous paracetamol versus combined diclofenac suppository and intravenous paracetamol for pain control after tonsillectomy or adenotonsillectomy in children.

Methods: This is a randomized controlled study involving 90 children aged between 1 and 7 years, classified as ASA I or II, scheduled to undergo tonsillectomy or adenotonsillectomy between February 2023 and February 2024 at Cairo University Hospitals.

Results: There was a statistically significant difference regarding FLACC score between the two groups (p=0.006) at 10 min after arrival to PACU, while it was not significantly different between the two groups on arrival or discharge from PACU (p=0.054 and 0.208, respectively). There was no statistically significant difference in PPPM between the two groups at 4, 12, and 24 hours postoperative (p=0.718, 0.470, and 0.738, respectively). Regarding the number of patients who received rescue analgesia (pethidine), they were fewer in group A (p=0.031), and the mean dose of pethidine received/kg as rescue analgesia was also significantly lower in group A (p=0.0316). The incidence of postoperative adverse events, i.e., nausea, vomiting, hypotension (low SBP = <70 + 2 (age in years)), bradycardia (less than 60 beats/min), drug allergic reaction, and postoperative bleeding requiring return to the operative room, was zero in the two groups.

Conclusion: The combination of intravenous ibuprofen and intravenous paracetamol was a more effective analgesic regimen than the combined rectal diclofenac and intravenous paracetamol in pediatric patients undergoing tonsillectomy or adenotonsillectomy without increased complications.