Comparative study between diclofenac and acetaminophen paediatric suppositories on perioperative pain management in orthopaedic paediatric surgeries

Background: In the paediatric age group, in particular, post-operative pain relief is a crucial part of patient care. Besides local anesthetic agents and opioids, NSAIDs are the most widely used for this purpose. This study is to comapre the effectivess of Diclofenac sodium suppositories versus Acetaminophen suppositories in perioperative pain releif in paediatric orthopaedic patients.

Methods: A prospective double-blind randomized comparative study included. Fifty children aged one to eight years undergoing differnt orthopefic surgies. They were randomly allocated to either (Group A) treated with Diclofenac suppositories at the dose of 1 mg/kg-3 or to (Group B) treated with Acetaminophen suppositories at the dose of 15 mg/kg-20 mg/kg. Pain relief assessed by using Faces-pain score from zero to five with a score of three or above is considered as a failure of  pain relief.

Results: The mean age was 4.2 +- 2.42 years, commonest age group was two years (22%=11 child). 29 (58%) patients from 50 received Diclofenac suppositories, 26 of them scored below or equal to two including 21 patients who underwent major or super-major surgeries. On the other hand, 21 (42%) patients received Acetaminophen suppositories, 20 of them scored three and above including 10 patients who underwent major or super-major surgeries, while only one patient scored two. This indicates a superior analgesic effect of Diclofenac as compared to Acetaminophen in decreasing postoperative pain (p<0.001).

Conclusion: Diclofenac sodium is better than acetaminophen in the treatment of postoperative pain in paediatric surgical orthopaedic practice.