The Effect of Rectal Diclofenac and Acetaminophen or their Combination on Postoperative Pain in Children Undergoing Cleft Palate Repair

Background and

As postoperative pain is inappropriately controlled in children and because narcotics are not used in children because of respiratory complications an appropriate analgesic with fewer side effects is essential. The aim of this study has been to investigate the effect of rectal diclofenac and acetaminophen or their combination on postoperative pain in children undergoing cleft palate repair. Methods and Materials: This double blind randomized clinical trial was conducted on 87 children undergoing cleft palate repair surgery. After obtaining informed consent they were randomly assigned into one of the three groups: rectal diclofenac (Group D) and acetaminophen (Group A) or their combination (Group A+D). Postoperative pain was measured and recorded 1 2 6 12 24 36 and 48 hours after surgery using CHOPES scale. For data analysis Smearnoff-Kolmogroff chi-square Fischer's exact test ANOVA and Kruskal-Wallis tests were used in SPSS.

According to the findings patients in Group D showed lower pain score (6.38±0.89) as compared with Group A (6.83±1.32) and Group A+D (6.5±1.12); also Group D had less opioid requirements (3 cases in Group D 26 in Group A and 24 cases in Group A+D). Patients in Group D were significantly different from those in the other two groups as for the time of first required dose of opioid in the postoperative period; mean for Group D was 2:55 hours after surgery (SD=2:44) group A 00:88 hours (SD=00:48) and Group A+D 00:85 hours (SD=1:12).

The present research suggests that rectal diclofenac (as compared with acetaminophen or a combination of both) is a more effective medication for postoperative pain alleviation in children undergoing cleft palate repair surgery.