The randomised prospective comparative study to see the duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children

Neerupam Gupta, Naine Bhadrala, Jasmeen ., Saloni .


Background: The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Author compared the analgesic efficacy and duration of analgesia of rectal acetaminophen and I.V. acetaminophen.

Methods: A total of 80 children in the age group of 2-5 years were randomly selected and divided into 2 groups. Group I received 15 mg/kg I.V. paracetamol and group II received 40 mg/kg rectal acetaminophen. Post-operative pain scores were measured using Face, Legs, Activity, Cry and Consolability scale and duration of analgesia were recorded and compared.

Results: The pain scores in group I was lower immediately after extubation and at 30 minutes post extubations but at one, two and four hours the pains score were comparable in both the groups. At 6 hours, the pain score was significantly more in I.V. group and also the duration of analgesia was 9-10 hours in rectal acetaminophen group where as in I.V. group, it was 5-6 hours.

Conclusions: Rectal acetaminophen 40 mg/kg produces prolonged analgesia as compared to I.V. paracetamol 15 mg/kg and also is more convenient and cost effective and is devoid of side effects of I.V. cannulation.


Adenotonsillectomy, I.V. paracetamol, Rectal acetaminophen

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Hurley RW, Wu CL. Acute postoperative pain. In: Miller RD, eds. Millers Anesthesia. 7th ed. Philadelphia; Churchill Livingstone/Elsevier; 2012: 2757-2777.

Razavi SS, Shaeghi S, Shiva H, Momenzadeh S. A comparison between Acetaminophen suppository and caudal anesthesia in relieving pain after pediatric surgery. Urol J. 2009;1(1):40-4.

Kashefi P, Mirdamadi M. Preemptive analgesia with ibuprofen and acetaminophen in pediatric lower abdominal surgery. J Res Med Sci. 2005;10:222-6.

Holmér Pettersson P, Öwall A, Jakobsson J. Early bioavailability of paracetamol after oral or intravenous administration. Acta Anaesthesiol Scandinavica. 2004;48(7):867-70.

Anderson BJ, Woolard GA, Holford NH. Phharmacokinetics of rectal acetaminophen after major surgery in children. Paediatr Anaesth. 1995;5:237-42.

Anderson BJ, Holford NH, Woollard GA, Kanagasundaram S, Mahadevan M. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiol J Am Soc Anesthesiol. 1999;90(2):411-21.

Birmingham PK, Tobin MJ, Fisher DM, Henthorn TK, Hall SC, et al. Initial and subsequent dosing of rectal acetaminophen in children: a 24-hour pharmacokinetic study of new dose recommendations. Anesthesiol J Am Soc Anesthesiol. 2001;94(3):385-9.

Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002;287(3):337-44.

Breivik H. Postoperative pain: toward optimal pharmacological and epidural analgesia. Pain. 2002;2002:337.

Candiotti KA, Bergese SD, Viscusi ER, Singla SK, Royal MA, Singla NK. Safety of multiple-dose intravenous acetaminophen in adult inpatients. Pain Med. 2010;11(12):1841-8.

Malaise O, Bruyera O, Reginster JY. Intravenous paracetamol: a review of efficacy and safety in theurapeutic use. Future Neurol. 2007;2(6):673-88.

Mahajan L, Mittal V, Gupta R, Chhabra H, Vidhan J, Kaur A. Study to compare the effect of oral, rectal, and intravenous infusion of paracetamol for postoperative analgesia in women undergoing cesarean section under spinal anesthesia. Anesthesia Essays Res. 2017;11(3):594.

Haddadi S, Marzban S, Karami MS, Heidarzadeh A, Parvizi A, Nabi BN. Comparing the duration of the analgesic effects of intravenous and rectal acetaminophen following tonsillectomy in children. Anesthesiol Pain Med. 2014;4(1).

Viitanen H, Tuominen N, Vääräniemi H, Nikanne E, Annila P. Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day‐case adenoidectomy. Brit J Anaes. 2003;91(3):363-7.

Paseron C, Standard D. The role of intravenous acetaminophen in pain management. Am Soc Pain Man. 2012;13(2):107-24.

Khalili GR, Shafa AM, Yousefi RA. Comparison of the effects of preemptive intravenous and rectal acetaminophen on pain management after inguinal herniorrhaphy in children: a placebo-controlled study. Middle East J Anaesthesiol. 2016;23:543-8.

Capici F, Ingelmo PM, Davidson A, Sacchi CA, Milan B, Sperti LR, et al. Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children. Brit J Anaesth. 2008;100(2):251-5.

Gaudreault P, Guay J, Nicol O, Dupuis C. Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen. Can J Anaesth. 1988;35(2):149-52.

Anderson B, Kanagasundarum S, Woollard G. Analgesic efficacy of paracetamol in children using tonsillectomy as a pain model. Anaesth Intensive Care. 1996;24(6):669-73.

Jibril F, Sharaby S, Mohamed A, Wilby KJ. Intravenous versus oral acetaminophen for pain: systematic review of current evidence to support clinical decision-making. Can J Hospital Pharmacy. 2015;68(3):238.