Effect of Two Regimens of Rectal Diclofenac on Post Adenotonsillectomy Pain in Children

Aim: To determine the post adenotonsillectomy analgesic effect of single versus divided dose regimen of rectal diclofenac in children.

Study Design: Prospective, randomized, double blind, comparative study.

Place and Duration of Study: University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria, from June to November, 2023.

Methodology: Following ethical approval (Ethical reference UPTH/ADM/90/S.II/VOL.XI/1285, granted 25th November, 2021) and parental consent, 50 children, of American Society of Anesthesiologists (ASA) class I and II, aged 1 – 6 years, were randomized into groups I and II, of 25 each. All children had intratracheal general anaesthesia induced with propofol, followed by atracurium, fentanyl, and maintained by isoflurane in 100% Oxygen. Group I received suppository diclofenac 2 - 3mg/kg rectally, in two divided doses 12 hours apart (first dose at induction), while group II received suppository diclofenac 2 - 3mg/kg rectally, as single dose (at induction). Pain was assessed using the Face, Leg, Arm, Cry, Consolability (FLACC) scale. The time to first analgesic request, (TTFAR) was defined as the period from rectal drug administration to pain score of ≥ 4. Analgesic was given when FLACC score was ≥ 4.

Results: All 50 subjects completed the study. The mean TTFAR (hours) was significantly more prolonged (7.82±1.18) in group I compared to 5.42±1.19 observed in group II, P = 0.0081, with significantly greater 24-hour analgesic consumption in group II, P = 0.0044, and 0.0003.

Conclusion: Suppository diclofenac administered rectally in two divided doses achieved significantly more prolonged postoperative analgesia compared to single equivalent dose.