Pain In Pediatric Patients Research Articles

Child appraisals of injustice in the context of acute and chronic pain: An interpretative phenomenological analysis.

Recent research has found child pain-related injustice appraisals to be associated with adverse pain-related outcomes. However, this evidence is mainly based on research using a measure developed for adults in the context of accident-related injuries, which may not translate to paediatric pain populations. Research on the phenomenology of child pain-related injustice appraisals is lacking. This study aimed to examine the phenomenology of pain-related injustice appraisals among both pain-free children and children living with chronic pain, to compare and contrast their experiences. Two focus groups were held with pain-free children (n = 16), and three focus groups were held with paediatric chronic pain patients attending a rehabilitation centre (n = 15) in Belgium. Interpretative phenomenological analysis was applied. Two injustice-related themes were generated from the focus groups with pain-free children: (1) 'Someone else is at fault' and (2) 'I am in pain and he is not'. Two injustice-related themes were generated from the focus groups with paediatric chronic pain patients: (1) 'People don't see my pain' and (2) 'I am missing out because of my pain'. This study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric pain patients. Findings highlight the interpersonal nature of lived injustice experiences caused by chronic pain, which is not fully captured by existing child pain-related injustice measures. Findings further suggest that pain-related injustice notions may not be extrapolated from a chronic to an acute pain context. The current study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric chronic pain patients. Findings highlight the interpersonal nature of injustice appraisals that are specific to the experience of chronic rather than acute pain. These appraisals are not fully captured by current child pain-related injustice measures.

Prevalence of chronic primary pain in pediatric patients. Ó?Dr. Eduardo LiceagaÓ� General Hospital of Mexico

Prevalence of chronic primary pain in pediatric patients. Ó?Dr. Eduardo LiceagaÓ� General Hospital of Mexico

Adherence in young people living with juvenile arthritis: A systematic review.

Juvenile idiopathic arthritis (JIA) is one of the leading causes of chronic pain in pediatric patients. Treatment regimens, which are critical to symptom management, can be burdensome, involving medication with potentially aversive side effects and exercise that can cause joint pain. Thus, it is important to examine the barriers and facilitators to adherence in JIA. While systematic reviews exist for rheumatic disease in adults, there has not yet been a synthesis of the literature examining adherence in JIA. PsychINFO, PubMed and MEDLINE databases were systematically searched to identify qualitative and quantitative empirical studies that investigate adherence for JIA. Keywords included: patient compliance OR adherence OR persistence; youth OR children OR juvenile OR pediatric OR teen OR child OR adolescent; and rheumatoid arthritis OR idiopathic arthritis OR arthritis. Articles were excluded from the review if they involved non-human or adult samples, were non-experimental (e.g., practice recommendations), were not peer-reviewed, or were not written in English. After abstract selection, 32 articles were included in the analyses. Adherence to exercise regimens was consistently lower than adherence to medication. Researchers relied heavily on self-report of adherence, which suggests a need for additional research with more objective measures of adherence. Across studies, psychological treatment was not included, so adherence to this treatment component in JIA remains understudied. Results suggest that future research should target devising and evaluating interventions to improve adherence to exercise and perhaps psychological treatment. To facilitate adherence in JIA, behavioral health providers should focus on building a strong therapeutic alliance between provider and child, fostering positive coping skills in parents and children, and monitoring the parent-child relationship.

Efficacy of non-pharmacological interventions to reduce pain in children with sickle cell disease: A systematic review.

Pain is the clinical hallmark of sickle cell disease (SCD) leading to hospitalization, psychological sequelae and a decreased health-related quality of life. The aim of this systematic literature review is to evaluate the efficacy of non-pharmacological interventions in reducing sickle cell related pain in children with SCD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive literature search up until October 2022 was performed to identify studies that investigated the efficacy of non-pharmacological interventions on (1) pain frequency and/or intensity, and (2) analgesic and health service use in children with SCD until the age of 21. Both randomized controlled trials (RCTs) and quasi-experimental designed (QED) studies were considered for inclusion. Ten articles (five RCTs and five QED studies) with 422 participants were included. They investigated cognitive behavioural therapy (CBT) (n=5), biofeedback (n=2), massage (n=1), virtual reality (n=1) and yoga (n=1). The majority of the interventions were psychological (n=7) and were performed in the outpatient clinic (n=6). CBT and biofeedback significantly reduced frequency and/or intensity of SCD-related pain in outpatient settings, while virtual reality and yoga significantly reduced pain in inpatient settings. Biofeedback also significantly reduced analgesic use. None of the included articles reported reduced health service use. Non-pharmacological interventions may be effective in reducing pain in paediatric patients with SCD. However, due to the heterogeneity of the included studies a quantitative analysis could not be performed. Awaiting further supporting evidence, healthcare providers should consider implementing these interventions as valuable part of a comprehensive pain management strategy plan.

Common Selfcare Indications of Pain Medications in Children.

Pain has a multifaceted impact on individuals worldwide, affecting their physical functioning, emotional well-being, and quality of life. Children (age <18 years) have a high prevalence of conditions associated with pain, such as toothache, headache, earache, sore throat, and respiratory tract infections, many of which may be accompanied by fever. Globally, the pharmacologic treatment of pain in pediatric patients is limited largely to nonopioid analgesics, and dosing must account for differences in age, weight, metabolism, and risk of adverse effects. This narrative review summarizes the findings of a literature search on the pediatric indications, dosing approaches, dosing guidelines, and pharmacokinetics of paracetamol and ibuprofen, which are common pain medications available globally for self-care use in children. The review also discusses the risks and benefits associated with these agents. The current roles of paracetamol and ibuprofen in the symptomatic management of coronavirus disease 2019 (COVID-19) infection and in the management of post-COVID-19 immunization symptoms in children are also discussed. Therefore, while a very large amount of data over several decades is available for paracetamol and ibuprofen, an urgent need exists for well-designed studies of these medications for the management of pain and fever in pediatric patients with COVID-19 to ensure optimal relief with minimal toxicity.

A Review of Pediatric Heel Pain.

The objective of this review article is to provide orthopaedic surgeons and general practitioners a reference and guidance for the evaluation and workup of heel pain in pediatric patients. The authors performed a comprehensive literature search to review the etiologies and management of heel pain in patients <18 years of age. Relevant studies in Medline/PubMed and EMBASE were searched from inception to March 3, 2022 using medical subject headings and text words without limitations on language or study type. The initial search utilized the following Boolean operators: (children) AND (heel pain); (pediatric) AND (heel pain). Heel pain in the pediatric population is usually a benign condition. Sever's apophysitis is the most common etiology of heel pain in pediatric patients.Most causes of heel pain in the pediatric population do not require imaging or extensive workup. However, providers must maintain a high index of suspicion for symptoms that could indicate a more severe pathology.

Paediatric pain management: from regional to virtual.

Due to increased interest in opioid-sparing multimodal analgesic strategies both inside and outside of the operating room, anaesthesiologists have started to look towards regional anaesthesia as well as nonpharmacological pain-reducing techniques. The purpose of this article is to discuss current trends and recent developments in regional anaesthesia and virtual reality for paediatric pain management. The development of novel fascial plane blocks has expanded regional options for anaesthesiologists, especially when neuraxial anaesthesia is not a viable or straightforward option. Other regional techniques, such as spinal anaesthesia and continuous epidural analgesia for infants and neonates, are becoming more popular, as more paediatric anaesthesiologists become familiar with these techniques. Virtual reality for paediatric pain management is a relatively new area of study that has shown promise, but more research needs to be done before widespread adoption of this practice becomes a reality. Various preexisting pain-reducing strategies such as distraction and biofeedback are being integrated with virtual reality to help optimize its effect on pain and anxiety for paediatric patients. Regional anaesthesia and virtual reality are valuable tools that serve to alleviate pain in paediatric patients. Advances are being made within both fields in various healthcare settings for different types of pain. Over the next few years, they will likely both play an increasing role in paediatric pain management.

Spinal cord stimulation for the treatment of intractable, chronic pain in paediatric patients: a presentation of two cases

Spinal cord stimulation for the treatment of intractable, chronic pain in paediatric patients: a presentation of two cases

Comparison of the anesthetic effect of alkalized lidocaine versus non-alkalized lidocaine administered at a slow rate in mandibular primary molars.

There are several invasive dental procedures that require local anesthetics. However, its infiltration is usually associated with anxiety and fear, increasing the perception of pain in pediatric patients. For this reason, it is important to evaluate different strategies for its application. We compared the anesthetic effect of the administration of 2% lidocaine with epinephrine 1:80000 non-alkalized at slow speed and alkalized at fast speed to block the inferior alveolar nerve in deciduous molars. A crossover clinical trial was carried out whose sample consisted of 38 patients between 6-10 years who required bilateral pulp treatment in their first mandibular primary molars. At the first appointment, they received 2% lidocaine with 1:80000 alkalinized epinephrine administered at a fast rate, and at the second appointment, 2% lidocaine with 1:80000 non-alkalized epinephrine administered at a low speed. We evaluated the onset of action, duration of the anesthetic effect, and intensity of pain during its infiltration. We found that non-alkalized lidocaine at slow speed had a shorter onset time of action (57.21±22.21 seconds) and longer duration of effect (170.82±43.75 minutes) compared to administration of alkalinized lidocaine at fast speed (74.03±22.09 seconds, 148.24±36.24 minutes, respectively). There was no difference in the level of pain intensity. In this study, the slow administration of the non-alkalized local anesthetic showed a shorter onset time of action and a longer duration of the anesthetic effect in comparison with the alkalized local anesthetic administered at a rapid rate in the blockade of the inferior alveolar nerve in deciduous molars.

Advances in the Cognitive Management of Chronic Pain in Children through the Use of Virtual Reality Combined with Binaural Beats: A Pilot Study

Chronic pain affects the quality of life of those affected. The need to investigate alternative and complementary methods to the pharmacological one to alleviate chronic pain is evident, so virtual reality and binaural tones have become a topic of interest in this field in recent years. This study aims to analyze the contributions of the combination of these two techniques in pediatric patients with chronic pain. For this, data on psychophysiological responses (heart rate and galvanic skin response) and pain perception are collected during and after interaction with this technology using a mixed pre- and posttest experimental methodology. The physiological data and answers in the Pediatric Pain Questionnaire (PPQ) have been collected in a sample of n = 13 healthy participants and n = 9 pediatric patients with chronic pain. The results show a significant difference between baseline and after applying virtual reality and binaural beats, md = 1.205 (t = 3.32; p &lt; 0.05 ). There are great effects on the perception of chronic pain if virtual reality and binaural beats are combined, even greater than with virtual reality alone, making this combination of technologies a very useful tool to be exploited for the management of chronic pain in pediatric patients with rheumatic diseases.

Is Virtual Reality a Game Changer in Pediatrics' Acute Pain Perception?

Purpose of review: Virtual reality (VR) is a promising tool that is becoming increasingly popular for the prevention and treatment of procedural pain in children. This review aims to investigate the current literature on the use and effectiveness of VR in paediatric procedural pain management, focusing on needle-related procedures, burn wound care, dental procedures among others; limitations and future perspectives on the use of VR will also be highlighted.&#x0D; Recent findings: in addition to the most researched fields of application (e.g. needle procedures), VR has also started to be used in new areas, such as nasal and gastrointestinal endoscopies as well as minor surgeries. From the latest evidence, VR seems to be effective in many procedures, especially compared to no distraction; however, there is conflicting data in the literature due to numerous factors such as differences between technologies, degree of VR-immersion, patients coping styles among others.&#x0D; Summary: there are still no data of absolute certainty on the effectiveness of VR in reducing procedural pain in paediatric patients and data pooling is still difficult. Future research should carry on large randomised-controlled, multicentre studies to better define VR properties and how best to optimise VR software and user experience for maximum pain reduction.

Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery

ABSTRACT Background Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults. Aims The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery. Methods Twenty-four patients (10–18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients’ self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients’ behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores. Results Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients’ self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters. Conclusions These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.

Codeine prescribing practices before and after the 2017 FDA warning at an academic health system

BackgroundIn April of 2017, the U.S. Food and Drug Administration (FDA) issued a boxed warning contraindicating codeine use in all patients younger than 12 years of age. ObjectivesThe purpose of this study was to describe changes in codeine prescribing practices across a broad range of professions and specialties before and after the boxed warning and identify opportunities for optimization of a health system-wide response to changes in evidence-based practice recommendations. MethodsPatients younger than 12 years of age with codeine-containing products prescribed between February 2017 and April 2018 at a single health system were included. Patient demographics, provider specialty, and prescription indication were collected by retrospective chart review. For categorical variables, frequency and percentage were calculated; for continuous variables, means with standard deviations or medians with interquartile ranges were calculated. ResultsCodeine prescriptions for patients younger than 12 years of age declined after the boxed warning issued by the FDA. Some provider specialties reacted promptly whereas others took longer to change their practice. Temporally, the largest decreases in prescribing centered around the month after the FDA communication release in April 2017 and the later implementation of electronic health record (EHR) alerts in June 2017. ConclusionGiven the persistence of codeine prescribing even after EHR soft-stop alerts were implemented, future pharmacy informatic responses to changes in evidence-based practice recommendations could be optimized using hard-stop alerts for high-impact recommendations. Studies comparing combination codeine products and other opioid medications for chronic pain in pediatric patients would be helpful to characterize the true level of risk in this population.

Bel Ağrısı Şikayeti ile Başvuran Çocuk Hastaların Spinal Manyetik Rezonans Görüntüleme Sonuçlarının İncelenmesi

ÖzetAmaç: Çocuk hastalarda bel ağrısı sonuçları itibarı ile ciddi olabilen ve araştırılması gereken bir durumdur. Bu çalışmada çocuk bel ağrılarının etyolojileri incelendi, yaş ve cinsiyet ile ilişkisinin olup olmadığı değerlendirildi.Gereç ve Yöntemler: Çalışmada 2021 yılında Şanlıurfa Eğitim ve Araştırma Hastanesi Fiziksel Tıp ve Rehabilitasyon ve Beyin ve Sinir Cerrahisi polikliniklerine bel ağrısı şikayeti ile başvurup Manyetik Rezonans Görüntüleme (MRG) yapılan 18 yaş altı 228 hasta retrospektif olarak incelendi.Bulgular: Çalışmamıza katılan 228 olgunun yaşları 4 ile 18 arasında değişmekte olup ortalama yaş 12.8±2.5 idi. Olguların %54.8’i erkek olup (n=125), %45.2’si (n=103) kadındı. Olguların 92 tanesinde MRG bulgusu gözlenmezken 136 olguda MRG’de bulguya rastlanmıştır. Olguların %44.7’sinde (n=102) disk patolojisi saptanmış olup, %14.9’unda (n=36) yapısal patoloji saptanmıştır. En sık görülen disk patolojisi bulging olup olguların %32.9’unu (n=75) oluşturmakta idi. Disk patolojisi görülme durumlarına göre olguların cinsiyetleri arasında anlamlı farklılık yoktu (p=0.434). Yaş ile disk patolojisi görülme durumudeğerlendirildiğinde, disk patolojisi olan grubun yaşı olmayana göre anlamlı olarak yüksekti (p&amp;lt;0.001). Olgularda en sık görülen yapısal patoloji skolyoz olup, cinsiyetler arasında anlamlı farklılık yoktu (p=0.083).Sonuç: Çocuk ve adolesan bel ağrıları ile karşılaşıldığında hasta ayrıntılı değerlendirilmeli, nonspesifik kas spazmına bağlı bel ağrıları olabileceği gibi MRG ile tanısı konabilen disk hastalıkları, skolyoz, listezis, neoplazm, enfeksiyon, konjenital deformite gibi durumlar olabileceği unutulmamalıdır.

Analgesia Nociception Index Monitoring in the Evaluation of Postoperative Pain in Children: A Prospective Observational Pilot Study

PurposeIn this study, we aimed to evaluate the relationship between the analgesia nociception index (ANI) device and pain scales used in the postoperative pain assessment of pediatric patients who underwent laparoscopic appendectomy. DesignThe study was designed as a correlation observational pilot study. MethodsPostoperative pain was evaluated using pediatric pain scales (face, legs, arms, cry, consolability scale; numerical rating scale; Wong–Baker scale) and ANI device in school-aged children and adolescents. ResultsThe mean age of the children was 14.00 ± 1.63 years, and the mean BMI was 22.52. We found a statistically significant positive correlation between the pain scale scores and a statistically significant negative relationship between the pain scale score and the ANI. ConclusionsThe ANI device can be used safely and constantly for the objective assessment of postoperative pain in pediatric patients.

The effect of intravenous infusion of lidocaine on the course of the perioperative period in children under 7 years of age

Annotation. At present, the treatment of perioperative pain syndrome in children remains unsolved. This issue is caused not only by a stereotypical approach to the assessment of pain intensity but also due to specific pharmacotherapy of pain in pediatric patients, especially those under the age of 7 years. The purpose of this study is to investigate the effect of intravenous infusion of lidocaine on the course of the perioperative period in children under the age of 7 years. We conducted a prospective controlled study that included 76 children (45 boys, 31 girls) who underwent surgical procedures under general anesthesia. Age of the patients was from 2 months to 7 years (3.72±2.26 years). Patients were divided into two groups: the first group (n=32) included children who received intravenous lidocaine during the perioperative period, and the second (control) group (n = 44) included children who were not prescribed lidocaine. Data analysis was performed using the statistical package "SPSS 20" (SPSS Inc.) version 21.0.0 for Windows. According to the obtained data, heart rate (HR) during operative procedures and a postoperative serum cortisol level were significantly lower in the lidocaine group compared to the control group (p&lt;0.05). The pressor response to extubation in patients of the study group was less pronounced; namely HR -109.63±14.09 bpm. to 120.75±7.61 bpm. in the control group (p&lt;0.001), the mean arterial pressure - 70.99±8.59 mm Hg to 75.59±7.24 mm Hg, respectively (p=0.017). During the 48-hour follow-up period after surgery, pain intensity according to the FLACC pain scale was significantly lower with lidocaine administration, similarly to the average doses of narcotic analgesics used perioperatively. Perspectives for further research include a subgroup analysis of the efficacy and safety of intravenous infusion of lidocaine over the course of the perioperative period in children, depending on the type and duration of surgical procedures.

Penggunaan Teknologi Sistem Informasi dan Manajemen sebagai Tehnik untuk Menurunkan Nyeri dan Ansietas pada Pasien Anak

This study aims to synthesize evidence/literature on the use of information system technology in applying active and passive distraction techniques to reduce pain scores in pediatric patients. The research method used in this study is a literature review. The research results based on the search for articles using the PICOT framework in the database Google Scholar were limited to the range of the last ten years, 2010-2020, which obtained five journals. The results showed that active and passive distraction techniques reduced pain scores in pediatric patients. In conclusion, active and passive distraction techniques can be used as non-pharmacological therapy that nurses can do to score pain in pediatric patients.&#x0D; &#x0D; Keywords: Distraction, Pain, Pediatric Patients

Virtual Reality Reduces Fear and Anxiety During Pediatric Orthopaedic Cast Room Procedures: A Randomized Controlled Trial.

Virtual Reality (VR) has been used as a distraction tool in various medical settings to reduce pain and anxiety associated with procedures. This study evaluates the effectiveness of VR as a distraction tool for decreasing fear, anxiety, and pain in pediatric patients undergoing common outpatient orthopaedic procedures. A total of 210 patients were recruited from a single orthopaedic clinic between October 2017 and July 2019. Patients were randomized to the VR group or to the control group (standard of care). Outpatient procedures included cast and/or pin removals. Primary outcome measures were collected preprocedure and postprocedure using validated surveys, and included: fear (Children's Fear Scale), anxiety (Children's Anxiety Meter-State), and pain (Numerical Rating Scale). Patients and caregivers in the VR group completed a satisfaction survey at the end of their appointment. Fear, anxiety, and pain scores between the 2 groups were analyzed using multivariable linear regression models, and the satisfaction survey was analyzed using descriptive statistics. One hundred twenty nine patients were included in the final analysis, with 85 patients in the VR group and 44 patients in the control group. During the procedure, patients in the VR group reported significantly lower average fear scores ( P <0.001) and anxiety scores ( P =0.003) as compared with controls. There were no differences between the groups in fear and anxiety scores before and after the procedure, or pain scores before, during, or after the procedure. Overall, patients and caregivers in the VR group reported high satisfaction scores, with 97% of patients and 95% of caregivers recommending this intervention to others. VR technology was found to be an effective distraction tool to improve fear and anxiety during cast removal procedures. Findings build on a body of evidence that supports the use of distraction tools in clinics, specifically pediatric orthopaedics, to improve fear and anxiety. The distraction tools can be easily translated into current practices. Level I.

Elevated serum TLR4 level as a potential marker for postsurgical chronic pain in pediatric patients with different approaches to analgesia.

IntroductionThe perioperative period of any surgery is accompanied by immune suppression. The level of Toll-like receptor 4 (TLR4) is known to increase in inflammation and after nerve injury and contributes to the development of neuropathic pain. The interaction of TLRs in response to the effect of opioids results in paradoxical hyperalgesia. Regional anesthesia techniques are the standard of care for perioperative pain management in children.AimThe aim of the study was to determine and evaluate the indicators of TLR4 for different methods of pain relief in anesthetic management of hernia repair in children and their effect on pain chronification.Materials and methodsThere were examined 60 children with inguinal hernia during 2020–2022. Children were divided into 3 groups: Group I included 20 children who underwent surgery under general anesthesia using the block of the anterior abdominal wall—transversalis fascia plane block (TFPB), combined with the quadratus lumborum block (QLB-4) via a single intramuscular injection; Group II included 20 children who underwent surgery under general anesthesia using the TFPB; Group III comprised 20 children who underwent surgery under general anesthesia using opioid analgesics. The levels of TLR4 were evaluated at a discharge from the hospital, 3 and 6 months after surgery.ResultsThere was no difference in age and body weight among all groups. In Group II, boys prevailed. In Group III, the length of hospital stay was the longest (3.28 ± 0.24 days, p < 0.05, t = 4.09) as compared to children of Group II and Group I (3.0 ± 0.30 (p < 0.05, t = 2.647) and 2.1 ± 0.16 days, respectively). While staying in the surgical department, children of Group III demonstrated significantly higher FLACC and VAS scores. The prevalence of chronic pain was the highest among children of Group III (35%) as compared to those in Group II and Group I (20 and 15%, respectively). The highest increase in the level of TLR4 was found in the group of opioid analgesia on the third and sixth months after surgery (68.86 + 10.31 pg/ml and 143.15 + 18.77 pg/ml (p < 0.05, t = 6.33), respectively) as compared to patients who received regional anesthesia.ConclusionsThere were confirmed the following advantages of the transversalis fascia plane block combined with the quadratus lumborum block (QLB + TFPB) via a single intramuscular injection: ease of use; adequate perioperative pain control as evidenced by the FLACC and VAS pain assessment scales; reduced perioperative use of opioid analgesics; shortening the length of hospital stay.

Postoperative pain relief in pediatric surgery patients: Effect of intravenous paracetamol in comparison with diclofenac suppository

Background: Pain is a major problem regarding quality of life in children undergoing surgicaloperation.Pain assessment is the most important and critical component of pain management. Oral andrectal paracetamol formulations are associated with a slower onset of action and more variableanalgesic activity than IV acetaminophen, making them less useful in preoperative and acute caresettings. Objective: To find out the effect of intravenous paracetamol in releiving postoperative pain in pediatricpatients. Settings and study design: This randomized clinical trial study was conducted in theAnaesthesiology department of Sir Salimullah Medical College Mitford Hospital,Dhaka fromFebruary' 2014 to August' 2014. A total of 100 cases were taken, they were randomly divided into twogroups in which one group received intravenous paracetamol and another group received diclofenacsuppository for the same operation performed on them, age of the children were between 4-12 years, andall were ASA grade I. Pain relief was assessed with VAS score from 30 minutes after surgery up to 6hours with regular follow up and comparison made between the two groups. Results: In this study, comparisons by mean visual analog scale between intravenous paracetamolwith diclofenac suppository groups were done. VAS score showed both analgesic reduces pain, butdiclofenac suppository was found better post operative pain reliever than intravenous paracetamolwithin observed 30 min to 2 hours. However observed after 6 hours, diclofenac suppository group issignificantly better than intravenous paracetamol group in relieving post operative pain by measuringVAS. Conclusion: Our study showed that diclofenac suppository is more effective than IV paracetamol inrelieving postoperative pain. However paracetamol is definitely a viable alternative to the NSA IDs,especially because of the lower incidence of adverse effects, and should be the preferred choice inhigh-risk patients. It may be appropriate to combine paracetamol with NSAIDs,but future studies arerequired especially after major surgery. JBSA 2022; 35 (2) : 37-42