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

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.