Post-tonsillectomy pain management in University of Port Harcourt Teaching Hospital: a comparison between suppository diclofenac and suppository acetaminophen
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Abstract
Background: Post-tonsillectomy pain management poses a challenge due to limited treatment options. With opioid analgesics largely contraindicated, non-opioid analgesics are mainstay of treatment.
Aim: This study compared effects of diclofenac and acetaminophen suppository on post-tonsillectomy analgesia and oral intake among paediatric patients at the institution of study.
Methods: This was a single blind randomized controlled study involving 60 paediatric patients undergoing tonsillectomy under GA, randomized into Groups A (diclofenac sodium suppository) and B (acetaminophen suppository) of 30 patients each for post-operative analgesia. Pain scores in both groups using the FLACC Scale 24 hours post-operatively, time to first oral intake and frequency, rescue analgesia and duration of hospital stay were monitored.
Results: Patients mean age was 3.71±1.30 years. Group A had lower pain scores across all time intervals (p = 0.01). Rescue analgesia was 19(63.4%) and 27(90.0%) in Groups A and B respectively (p = 0.05). Although the difference in time to first oral intake was shorter in Group A (388.7min vs 488.7min; p = 0.33), frequency of oral intake (p = 0.01) and duration of hospital stay (p = 0.05) were better in Group A.
Conclusion: Diclofenac suppository was more effective for post-tonsillectomy pain than acetaminophen suppository. Rescue analgesia requirement was high in both groups but significantly lesser in Group A. No significant difference occurred in time to first oral intake, but there was significantly better oral intake and lesser duration of hospital stay in Group A.
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References
1. Derkay CS. Pediatric otolaryngology procedures in the United States: 1977–1987. Int J Pediatr Otorhinolaryngol 1993; 25:1-12.
2. Onotai L, da Lilly-Tariah OB. Adenoid and tonsil surgeries in children: How relevant is pre-operative blood grouping and cross-matching? Afr J Paediatr Surg 2013; 10(3):231-234.
3. Okafor BC. Tonsillectomy: an appraisal of indications in developing countries. Acta Otolaryngol 1983; 96(5-6):517-522.
4. da Lilly-Tariah OB, Peterside OA. The Scope of ear, nose and throat surgeries in the theatre in University of Port Harcourt Teaching Hospital. J Med Trop 2008; 10(1):15-22.
5. Somefun AO, Nwawolo CC, Mazai AE, Okeowo PA. Adenoid and tonsil operations: An appraisal of indications and complications. Niger J Surg 2000; 7(1):16-19.
6. Ameye SA, Owojuyigbe AM, Adeyemo A, Adenekan AT, Ouche S. Pediatric adenotonsillectomy in a low resource setting: Lessons and implications. Niger J Surg 2016; 22(2):77-80.
7. Ibekwe UM, Oghenekaro E. Post-adenotonsillectomy analgesia in children: the place of non-steroidal anti-inflammatory drugs. Port Harcourt Med J 2019; 13(1):41-45.
8. Onotai LO, Ebong EJ. Day-case adenoid and tonsil surgeries in children: a private clinic experience in a resource poor country. J Med Res Pract 2013; 2:144-147.
9. Onotai LO, Nwankwo NC. A review of the Nigerian healthcare funding system and how it compares to that of South Africa, Europe and America. J Med Med Sci 2012; 3(4):226-231.
10. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144(1 Suppl): S1-30.
11. Abou-Jaoude PM, Manoukian JJ, Daniel SJ, Balys R, Abou-Chacra Z, Nader ME, et al. Complications of adenotonsillectomy revisited in a large pediatric case series. J Otolaryngol 2006; 35(3):180-185.
12. Jadad AR, Browman GP. The WHO Analgesic Ladder. JAMA 1995; 274(23):1870-1873.
13. Sutters KA, Isaacson G. Post tonsillectomy pain in children. Am J Nurs 2014; 114(2):36-42.
14. Lavonas EJ, Reynolds KM, Dart RC. Therapeutic acetaminophen is not associated with liver injury in children: a systematic review. Pediatrics 2010; 126(6): e1430-1444.
15. Li C, Martin BC. Trends in emergency department visits attributable to acetaminophen overdoses in the United States: 1993-2007. Pharmacoepidemiol Drug Saf 2011; 20(8):810-818. 16. Kokki H. Nonsteroidal anti-inflammatory drugs for postoperative pain: a focus on children. Pediatr Drugs 2003; 5:103-123.
17. Redmann AJ, Wang Y, Furstein J, Myer CM 3rd, de Alarcon A. The use of the FLACC pain scale in pediatric patients undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2017; 92:115-118.
18. Ubale P, Trasy V. Comparison of analgesic efficacy of diclofenac sodium suppository over acetaminophen suppository for post tonsillectomy pain relief in pediatric age group: randomized study. Anaesth Pain Intensive Care 2016; 20(2):137-142.
19. Tawalbeh MI, Nawasreh OO, Husban AM. Comparative study of diclofenac sodium and paracetamol for treatment of pain after adenotonsillectomy in children. Saudi Med J 2001; 22(2):121-123.
20. Romsing J, Ostergaard D, Drozdziewicz D, Schultz P, Ravn G. Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients. Acta Anaesthesiol Scand 2000; 44(3):291-295.
21. Merry AF, Edward KE, Ahmad Z, Barber C, Mahadevan M, Frampton C. Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children. Can J Anesth 2013; 60(12):1180-1189.
22. Yallapragada SV, Shenoy T. Comparison of preoperative rectal paracetamol with paracetamol-diclofenac combination for postoperative analgesia in pediatric surgeries under general anaesthesia. Anesth Essays Res 2016; 10(2):301-304.
23. Furst DE, Ulrich RW, Varkey-Altamirano C. Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, nonopioid analgesics, and drugs used in gout. In: Katzung BG, Masters SB, Trevor AJ (eds). Basic and clinical pharmacology, 11th edn. Singapore: McGraw-Hill, 2009; 622-624.
24. Møiniche S, Rømsing J, Dahl JB, Tramèr MR. Nonsteroidal anti-inflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003; 96(1):68-77.
25. Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. Arch Otolaryngol Head Neck Surg 2003; 129(10):1086-1089.
26. Riggin L, Ramakrishna J, Sommer DD, Koren G. A 2013 updated systematic review and meta-analysis of 36 randomized controlled trials; no apparent effects of non-steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 2013; 38(2):115-129.
27. Cardwell ME, Siviter G, Smith AF. Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev 2005;(2):CD003591. Update in: Cochrane Database Syst Rev 2013;(7):CD003591.
28. Grosser T, Smyth E, FitzGerald GA. Anti-inflammatory, antipyretic, and analgesic agents; Pharmacotherapy of gout. In: Brunton LL, Chabner BA, Knollmann BC (eds). Goodman and Gilman’s The pharmacological basis of therapeutics, 12th edn. China: McGraw-Hill, 2011; 962-977.
29. Sun GH, Auger KA, Aliu O, Patrick SW, DeMonner S, Davis MM. Posttonsillectomy hemorrhage in children with von Willebrand disease or hemophilia. JAMA Otolaryngol Head Neck Surg 2013; 139(3):245-249.