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A comparative evaluation of per rectal diclofenac sodium and paracetamol for postoperative analgesia in case of hydrocephalus

Mrugank M Bhavsar, Divya Kheskani, Parth Shah, Ashish Tyagi, Rama Upadhyaya.


Background: Hydrocephalus is one of the most painful conditions, especially in pediatric population. Analgesia after neurosurgery requires good communication and close cooperation between members of the perioperative team. Diclofenac is a nonsteroidal anti-inflammatory drug with pronounced antirheumatic, anti-inflammatory, analgesic, and antipyretic properties. Diclofenac inhibits prostaglandin synthesis, which contributes to inflammation, pain, and fever. Paracetamol produces analgesia and antipyresis by a mechanism similar to that of salicylate, which involves inhibition of prostaglandin synthesis.

Objectives: To compare the analgesic efficacy of rectally administered diclofenac sodium and paracetamol postoperatively in patients with hydrocephalus for postoperative pain relief. Also, to compare side effects of both the drugs.

Materials and Methods: Fifty patients aged 1-8 years scheduled for ventriculoperitoneal shunt under general anesthesia were selected for the study. All the patients were divided into two groups, Group D and Group P. At the end of surgery, 15 min before extubation, patients of Group D were rectally administered with inj. diclofenac 1 mg/kg whereas those of Group P with inj. paracetamol 15 mg/kg. Pain was assessed using Wong–Baker Faces Pain Rating Scale (WBFPS). When the score was 4 or more, then inj. paracetamol 15 mg/kg was administered intravenously as rescue analgesia. Patients were also observed for duration and analgesia. We have also compared hemodynamic parameters and complications in both the groups postoperatively.

Results: Heart rate and SpO2 were stable in after the operation. Pain score on WBFPS was statistically nonsignificant between both the groups. Duration of analgesia was significantly longer in Group D than in Group P. Incidence of side effects and complications were also comparable in both the groups.

Conclusion: We conclude that both paracetamol and diclofenac are very well tolerated by rectal route with prolonged duration of analgesia with diclofenac for postoperative pain relief in pediatric patients with hydrocephalus.

Key words: Diclofenac, paracetamol, perrectal, ventriculoperitoneal shunt

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