Post-tonsillectomy pain management in University of Port Harcourt Teaching Hospital: a comparison between suppository diclofenac and suppository acetaminophen

Background: Post-tonsillectomy pain management poses a challenge due to limited treatment options. With opioid analgesics largely contraindicated, non-opioid analgesics are mainstay of treatment. Aim: This study compared effects of diclofenac and acetaminophen suppository on post-tonsillectomy analgesia and oral intake among paediatric patients at the institution of study. Methods: This was a single blind randomized controlled study involving 60 paediatric patients undergoing tonsillectomy under GA, randomized into Groups A (diclofenac sodium suppository) and B (acetaminophen suppository) of 30 patients each for post-operative analgesia. Pain scores in both groups using the FLACC Scale 24 hours post-operatively, time to first oral intake and frequency, rescue analgesia and duration of hospital stay were monitored. Results: Patients mean age was 3.71±1.30 years. Group A had lower pain scores across all time intervals (p = 0.01). Rescue analgesia was 19(63.4%) and 27(90.0%) in Groups A and B respectively (p = 0.05). Although the difference in time to first oral intake was shorter in Group A (388.7min vs 488.7min; p = 0.33), frequency of oral intake (p = 0.01) and duration of hospital stay (p = 0.05) were better in Group A. Conclusion: Diclofenac suppository was more effective for post-tonsillectomy pain than acetaminophen suppository. Rescue analgesia requirement was high in both groups but significantly lesser in Group A. No significant difference occurred in time to first oral intake, but there was significantly better oral intake and lesser duration of hospital stay in Group A.