(1011) Demonstration of the Analgesic Effect of Intranasal Diclofenac Sodium, Ibuprofen, and Paracetamol in Pediatric Tonsillectomy

Introduction: Tonsillectomy is the oldest and most frequently performed surgical procedure in otolaryngology. Postoperative pain management is still an unsolved problem. In this study, we aimed to demonstrate the efficacy of intranasal (IN) Diclofenac Sodium, Ibuprofen, and Paracetamol for pain relief after tonsillectomy in children.

Methods: This is a randomized and controlled trial. To evaluate the effects of IN Diclofenac Sodium, IN Ibuprofen and IN Paracetamol on post tonsillectomy pain in children undergoing tonsillectomy. A total of 63 children who underwent tonsillectomy were randomly divided into 4 groups. Group I: Intravenous (IV) paracetamol (10 mg/kg), Group II received IN Ibuprofen (1.5 mg/kg ketamine), Group III received IN Diclofenac Sodium (1.5 mcg/kg), and Group IV: Intravenous (IV) paracetamol (10 mg/kg). Postoperative scores of 15, 30, 60 minutes, 2 hours, 6 hours, 12 hours, and 24 hours Modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson Sedation Scale were recorded. Patients were followed up to evaluate pain, nightmares, delusions, nausea, vomiting, and bleeding after surgery.

Results: At 15, 30, 60 minutes and 2, 6, 12 and 24 hours in CHEOPS, IN ketamine and IN fentanyl provided a significantly stronger analgesic effect compared to postoperative IV administration of paracetamol (p < 0.05). According to the Wilson Sedation Scale, sedative effects were observed in 3 patients in the IN ketamine administration group. No such sedative effect was seen in the groups receiving IN fentanyl and IN paracetamol (p < 0.05). Cognitive impairment, constipation, nausea, vomiting, and bleeding were not observed in any group.

Conclusions: This study showed that IN ketamine and IN fentanyl were more effective than IV paracetamol for postoperative analgesia after pediatric tonsillectomy. A sedative effect was observed in three patients in the IN ketamine group. There was no significant difference between IN ketamine and IN fentanyl in terms of efficacy in post-tonsillectomy analgesia.