Effect of Preoperative Rectal Diclofenac Suppository on Post Operative Analgesic Requirement in Cleft Palate Repair – A Randomized Clinical Trial

Abstract

Background ABSTRACT Inadequate analgesia in children besides its psychological effects, causes restlessness, excitability, tachycardia and increased oxygen consumption. Opioid analgesics used for analgesia are associated with sedation , respiratory depression and PONV. NSAIDs such as diclofenac is safe , effective and has shown to have an opioid sparing effect. Objective To evaluate the effectiveness of pre-operative rectal diclofenac ( 1mg/kg ) in Cleft palate repair for post-operative analgesia and reduction in opioid requirements. Study design A randomized clinical trial Methods After obtaining approval from the institutional ethical committee, 60 children were allocated by computer generated randomization into two groups of 30 each; group D ( Diclofenac group ) and group C ( Conventional group ) . Children in group D and group C were similar in all aspects except for the fact that Group D children received 1mg/kg Diclofenac suppository after induction . Pain scores were evaluated using modification of objective pain scale by Hannallah and colleagues at frequent intervals for 6 hrs postoperatively by anaesthesiology P.G. or nursing staff in the recovery room who were blinded to the group. If the pain score was > 3 , rescue analgesic I.V fentanyl 0.5µgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required was noted. All the data collected was processed statistically . X Results We observed that preoperative rectal diclofenac provided effective analgesia in immediate post-operative period as evidenced by reduced pain scores and reduced opioid requirement ( P=0.00002) . There was no evidence of any increased perioperative bleeding in diclofenac group. Conclusion Preoperative rectal diclofenac reduces opioid consumption and provides good post- operative analgesia.