The Effects of topical viscous lignocaine 2% versus per-rectal diclofenac in early post-tonsillectomy pain in children

Abstract 

Introduction

Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non-opioid analgesic such as NSAIDs and local anaesthetics.

Objective

The aim of this study was to evaluate the efficacy between 2% viscous lignocaine and sodium diclofenac based upon the visual analogue scores (VASs), consumption of pethidine 0.5mgkg⁻¹ as the rescue drug postoperatively and time taken to resume feeding.

Methods

130 patients aged between 5 and 12 years old were randomly allocated into 2 groups to be given either 2% viscous lignocaine 4mgkg⁻¹ body weight topically post-tonsillectomy or sodium diclofenac 1mgkg⁻¹ per-rectal post-induction of anaesthesia. Postoperatively visual analogues score was done for 24h, the amount of pethidine given and time when the patient start taking oral feeding of clear fluid, soft diet and normal diet were documented.

Results

There was no significant difference in the visual analogue scores in both groups, however the requirement of pethidine as the rescue drug postoperatively was significant 2h post-tonsillectomy (p=0.023) in viscous lignocaine group compared to sodium diclofenac. The time taken to resume oral feeding and soft diet was also significant in viscous lignocaine group (p=0.016 and p=0.007) whereas there was no significant in taking normal diet.

Conclusion: We concluded that 2% viscous lignocaine applied topically post-tonsillectomy is comparable to sodium diclofenac per-rectal in providing analgesia and faster oral feeding.

Keywords: Tonsillectomy, Analgesics, 2% viscous lignocaine, Sodium diclofenac, Visual analogue score