Comparative study of diclofenac sodium and paracetamol for treatment of pain after adenotonsillectomy in children.

OBJECTIVE: To compare the analgesic efficacy of diclofenac sodium and paracetamol on post adenotonsillectomy postoperative pain and oral intake. METHODS: Between January 1999 and July 2000, 80 children aged 3-14 years, underwent tonsillectomy and adenoidectomy for either recurrent tonsillitis or adenotonsillar hypertrophy in Prince Zeid Ben Al-Hussein Hospital and Prince Rashid Ben Al-Hussein Hospital. Forty-one children received diclofenac sodium suppositories (1-3mg/kg) postoperatively, whereas 39 children received only paracetamol syrup (10-15 mg/kg) in 4 divided doses. All children were observed for postoperative pain, oral intake, vomiting, temperature and complications. RESULTS: Children who received diclofenac sodium had significantly less pain, less elevation of temperature, more oral intake, and started drinking significantly sooner than the paracetamol group. Two children in the diclofenac group experienced nausea and vomiting compared to 12 children in the paracetamol group in the first day. The time to first solid intake was significantly earlier in the diclofenac sodium group (p < 0.0001). With regard to complications, one patient in each group developed secondary hemorrhage, one child developed otitis media in the 2nd group. Each group had one readmission, and 2 children from the paracetamol group had an emergency department visit for pain and dehydration. CONCLUSION: Diclofenac sodium has a significant effect on decreasing the pain associated with swallowing postoperatively and on the general condition of the patient. Improved oral intake resulted in a lower incidence of nausea and vomiting and allowed safer and earlier hospital discharge.

Sinusitis as a cause of orbital cellulitis.

To determine the importance of sinusitis as a cause of orbital cellulitis, the causative organisms and peak age of occurrence, 25 patients hospitalized with orbital cellulitis (ages 8 months to 17 years; 80%, 1-4 years) were studied. Complete blood counts were carried out and radiographic sinus examinations and eye swabs (for culturing) performed prior to antibiotic treatment. Sinusitis was evident in 72% of the patients. Eye swab cultures indicated 80% had streptococcal, staphylococcal or enterococcal infection. The data indicate that sinusitis is an important cause of orbital cellulitis. The most common causative organisms were Streptococcus viridans (44%) and Staphylococcus aureus (32%). Initial antibiotics should therefore cover both organisms.