Effects of scheduled ibuprofen combined with diclofenac suppository on postoperative pain in children undergoing pectus excavatum correction: a randomized controlled trial

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for postoperative acute pain management. However, the safety and efficacy of postoperative scheduled oral ibuprofen remain unclear in children. The purpose of this study was to evaluate the efficacy and safety of scheduled ibuprofen combined with diclofenac suppository for postoperative analgesia in children following the Nuss procedure for pectus excavatum. Methods Sixty patients who underwent the Nuss procedure from September 2024 to August 2025 were randomly divided and assigned to either the experimental or control group. The experimental group received scheduled ibuprofen combined with a diclofenac suppository, whereas the control group received a diclofenac suppository and ibuprofen on demand. The postoperative visual analog scale (VAS) scores, supplemental opioid consumption, time to first ambulation, length of hospital stay, and incidence of adverse events were recorded for both groups. Results The VAS scores at 6–24 h postoperatively were significantly lower for the experimental group than the control group ( p < 0.05). The experimental group required less opioids than the control group (62.4 ± 5.7 vs. 67.5 ± 6.4 µg, p = 0.002; difference: −5.167 µg, 95% confidence interval: −8.325 to −2.008). Additionally, the time to first ambulation (5.9 ± 0.6 vs. 6.4 ± 0.7 h, p = 0.005; difference: −0.486 h, 95% confidence interval: −0.924 to −0.076) and length of hospital stay (6.8 ± 0.8 vs. 7.3 ± 0.8 days, p = 0.022; difference: −0.500 days, 95% confidence interval: −0.924 to −0.076) were shorter for the experimental group than the control group. The incidence of adverse events was similar for both groups ( p > 0.05). Conclusion This study indicates that scheduled ibuprofen combined with diclofenac suppository provides effective analgesia following the Nuss procedure, reduces opioid consumption, and promotes recovery. No serious NSAID-related adverse events were observed during the short postoperative observation period. However, the study was not powered to establish safety or exclude clinically important differences in uncommon adverse events. Clinical Trial Registration https://www.chictr.org.cn/ , identifier ChiCTR2400089927.