Intravenous paracetamol and dipyrone for postoperative analgesia after day-case tonsillectomy in children: a prospective, randomized, double blind, placebo controlled study

Aysu Inan Kocum,Mesut Sener,Esra Caliskan,Nesrin Bozdogan,Deniz Micozkadioglu,Ismail Yilmaz,Anis Aribogan

doi:10.5935/1808-8694.20130015

Aysu Inan Kocum, Mesut Sener + Show 5 more

Open Access

https://doi.org/10.5935/1808-8694.20130015

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Abstract

Tonsillectomy is associated with severe postoperative pain for which, several drugs are employed for management. ObjectiveIn this double-blind, placebo-controlled study we aimed to evaluate the efficacy of intravenous paracetamol and dipyrone when used for post-tonsillectomy analgesia in children. Method120 children aged 3-6 yr, undergoing tonsillectomy with or without adenoidectomy and/ or ventilation tube insertion were randomized to receive intraoperative infusions of paracetamol (15 mg/kg), dipyrone (15 mg/kg) or placebo (0.9% NaCl). Evaluation was carried out at 0.25, 0.50, 1, 2, 4, 6h postoperatively. Pethidine 0.25 mg/kg was utilized as rescue analgesic. Cumulative pethidine requirement was the primary outcome. Pain intensity measurement, pain relief, sedation level, nausea and vomiting, postoperative bleeding and any other adverse effects were noted. ResultsNo significant difference was found in pethidine requirement between paracetamol and dipyrone groups. Cumulative pethidine requirement was significantly less in paracetamol and dipyrone groups vs. placebo. No significant difference was observed between groups in postoperative pain intensity scores throughout the study. ConclusionIntravenous paracetamol is found to have a similar analgesic efficacy as intravenous dipyrone and they both help to reduce the opioid requirement for postoperative analgesia in pediatric day-case tonsillectomy.

Highlights

Tonsillectomy with or without adenoidectomy is associated with severe postoperative pain and presently forms a major part of day-case pediatric anesthetic management[1]
Intravenous paracetamol is found to have a similar analgesic efficacy as intravenous dipyrone and they both help to reduce the opioid requirement for postoperative analgesia in pediatric day-case tonsillectomy
Paracetamol in oral and rectal suppository forms have long been used for postoperative analgesia in children[12]; irregular bioavailability of rectal form and temporary prohibition of oral intake in post tonsillectomy patients are important factors limiting the use of paracetamol in immediate postoperative management of pain following tonsillectomy[13]

Summary

Introduction

Tonsillectomy with or without adenoidectomy is associated with severe postoperative pain and presently forms a major part of day-case pediatric anesthetic management[1]. It is important to provide effective and safe pain control in this patient group allowing early ambulation. Potential for respiratory depression, nausea and vomiting limits the use of opioid analgesics in this patient group when care of the patient is parents’ responsibility after early discharge[2,3] following a surgical procedure involving the upper respiratory pathway[4]. Paracetamol in oral and rectal suppository forms have long been used for postoperative analgesia in children[12]; irregular bioavailability of rectal form and temporary prohibition of oral intake in post tonsillectomy patients are important factors limiting the use of paracetamol in immediate postoperative management of pain following tonsillectomy[13]

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Discussion

Conclusion