Prospective Randomized TrialsThe analgesic effects of rectal diclofenac versus rectal paracetamol following caudal-bupivacaine for pediatric day-case inguinal herniotomies: a randomized controlled prospective trial

BackgroundPostoperative pain is a common complaint in day-case inguinal herniotomy, thus there is a need to provide effective analgesia. This study compared the postoperative analgesic effects of the combinations of caudal-bupivacaine and rectal diclofenac with caudal-bupivacaine and rectal-paracetamol in children scheduled for daycase inguinal-herniotomy.MethodsNinety children of ASA I scheduled for elective day-case inguinal-herniotomy were randomly assigned into Group A (1 ml/kg of 0.25% caudal-bupivacaine and 1 mg/kg rectal-diclofenac), Group B (1 ml/kg of 0.25% caudal-bupivacaine and 30 mg/kg rectal paracetamol) and Group C (1 ml/kg of 0.25% caudal-bupivacaine). The duration of analgesia, pain scores, postoperative analgesic consumption and side effects were assessed and recorded. Data collected was analyzed with the statistical package for social sciences 17 for windows.ResultsEighty-seven children completed the study, and it was found that the duration of analgesia was prolonged in Group A compared to Groups B and C (p < 0.01).ConclusionCaudal-bupivacaine and rectal-diclofenac combination provides a more prolonged postoperative analgesia, and lower pain score compared to caudal-bupivacaine and rectal-paracetamol combination or caudal-bupivacaine alone.Level of evidenceLevel 1 evidence treatment study. Randomized controlled trials with adequate statistical power to detect differences (narrow confidence intervals) and follow up > 80%.