ABSTRACT
Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using “Modified Steward Coma Scale”at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group- P40 was (646±9.94) min Group- D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.
ABSTRACT
Background: Bleeding during functional endoscopic sinus surgery (FESS) remains a challenge for both surgeons and anaesthesiologists despite several modalities available for improving the surgical field. This study was conducted to evaluate the effect of oral clonidine premedication on blood loss and the quality of the surgical field in FESS. Methods: This prospective placebo controlled trial was performed on 120 patients (ASA I, ASA II). Patients undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyposis were randomly allocated to receive either oral clonidine 0.005mg/kg or identical-looking placebo tablets 90 min before arrival at the operating room. During general anaesthesia, the hemodynamic endpoint of the anaesthetic management was maintenance of hypotension (Mean Arterial Presure) at ≤ 65 mmHg for producing a bloodless surgical field. The control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. Intraoperative bleeding was assessed on a six – point scale from 0 (= no bleeding) to 5 (= severe bleeding). Data were compared with chisquare test, fisher's exact test and Student t-test. Results: There was less bleeding volume in the clonidine group (mean±SD) than in the placebo group (140.7±65.4 Vs 199.2±104.4, P<0.05). Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction) were lower in the clonidine group than in the placebo group (13.3 Vs 33.3%, P< 0.05). ). Accordingly, the surgeon was more satisfied with the surgical field in the clonidine group than with that in the placebo group. Conclusion: In conclusion, premedication with oral clonidine can effectively reduce bleeding during endoscopic sinus surgery.