Abstract
Abstract 
 urgent surgical intervention and appendectomy until now represent standard treatment for uncomplicated cases of appendicitis. Nausea, vomiting and pain after surgery are the most frequent issues facing patients and affecting patient quality of life and responsible for many cases of readmission after surgery. Ketorolac and diclofenac represent the most commonly prescribed non-steroidal anti-inflammatory used in postoperative setting and they cause many side effects as gastrointestinal, kidney and cardiac adverse effect in addition to increased risk of bleeding. Paracetamol is currently among the most frequently prescribed medication worldwide and it can be used safely for all age groups. This study aimed to compare the analgesic efficacy and safety of paracetamol, diclofenac, and ketorolac when used after appendectomy and to assess their efficacy regarding nausea and vomiting in children and adolescents. A randomized, single-blinded, comparative, observational prospective clinical study was carried out on patients diagnosed with acute appendicitis and assigned for emergent appendectomy between October 2018 to May 2019 in Al- Zahraa Teaching Hospital in Al-Najaf province, Iraq.120 patients were randomly distributed into three groups who received diclofenac sodium suppositories (2mg/kg), IV Paracetamol )15mg/ kg every 6 hr.(, and IV Ketorolac )0.5mg/ kg( immediately after surgery. All patients were observed for pain, nausea and vomiting and bleeding. Patients received ketorolac had a high percentage of the decrease in pain score between 30 and 60 min. after surgery, while paracetamol was the next and diclofenac sodium was the last. Regarding nausea and vomiting after surgery, ketorolac had higher percentage of the decrease in nausea, vomiting score during first day after surgery followed by diclofenac and paracetamol respectively. The present study also showed that there is no significant difference between groups regarding bleeding after surgery. It is concluded that ketorolac has higher analgesic efficacy compared with paracetamol and diclofenac with no risk of nausea and vomiting and bleeding when used after appendectomy.
 Keywords: Postoperative pain, Ketorolac, Diclofenac, Paracetamol, Appendectomy.
Highlights
Acute appendicitis is considered one of the most frequent abdominal condition that faces children population and needs an urgent surgical procedure [1]
The aim of this study was to compare the analgesic efficacy and safety of paracetamol, diclofenac, and ketorolac when used after appendectomy and to assess their efficacy regarding postoperative nausea and vomiting in children and adolescents
The inclusion criteria for enrolling patients in the study were: 1- Patients diagnosed with acute appendicitis, 2- Aged between 4-14 years with no history of allergy or contraindication to ketorolac, diclofenac or paracetamol. 3- Taking the same analgesia for 3 consecutive days without any rescue analgesic and taking the same antibiotic regime mentioned later in this study
Summary
Acute appendicitis is considered one of the most frequent abdominal condition that faces children population and needs an urgent surgical procedure [1]. Appendectomy can perform either by open surgery or laparoscopic procedure. It accounts for more than half of the operations that are done in the emergency room and constitutes about 10-30% of pediatric emergency operations[3,4]. Surgical treatment of acute appendicitis by open surgery approach is considered a clean-contaminated surgery and still has good outcomes with acceptable complication rate (11.1%) and mortality rate of less than 0.5% which is related to the operation itself [5,6,7,8]. The complications after appendectomy are rare and include surgical site infection (1.2-12%), intra-abdominal abscess (1.8-8%), small intestine obstruction (0-1.9%) and lesser percent present with stump leakage and stump appendicitis[9,10]
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