Comparison of the influence of oral and rectal acetaminophen on level of pain relief after circumcision

Postoperative pain is a major problem in day-care pediatric surgery and acetaminophen is a common drug, which is used for pain control in infants. The aim of this study was to compare the effect of oral and rectal acetaminophen and also to evaluate the effect of loading single dose of rectal acetaminophen before surgery in pain relief after circumcision. In a randomized clinical trial, 45 children (3 to 6 years old) were divided into 3 groups before circumcision. The first group was received rectal acetaminophen (40 mg/kg) before and oral acetaminophen (15 mg/kg/qid) after circumcision. The second group was given rectal and the third group received oral acetaminophen (both 15 mg/kg/qid) after circumcision. Pain scores was measured every three hours and the amount of sleep hours in the first 24-hours after circumcision. In the study, pain scores and amount of sleep hours in the first group were significantly lower and higher than other groups. There was no significant difference in pain scores between other groups (second and third) but the amount of sleep hours was higher in second group. Efficacy of oral and rectal acetaminophen (15 mg/kg/qid) was similar in pain relief after circumcision but rectal acetaminophen had more sedative effect. In addition, the high dose of rectal acetaminophen (40 mg/kg) before circumcision significantly led to pain reduction in the first 24-hours after circumcision.