Comparison of Analgesic Effects of Intravenous or Rectal Acetaminophen for Controlling Post-Tonsillectomy Pain

Mahin Seyedhejazi, Yalda Jabbari Moghaddam, Daryoush Sheikhzadeh, Mojtab Sohrabpour, Nasrin Taghizadieh


Background: Acetaminophen is a simple analgesic and antipyretic administered in varied formats and from different routes. The purpose of this study was to compare the efficacy of intravenous (IV) and rectal acetaminophen (RA) for controlling post-tonsillectomy pain. Methods: In a double-blinded randomized clinical trial, 70 children scheduled for adenotonsillectomy were randomly allocated into two groups, each containing 35 patients.In the first group, 40 mg/kg of rectal acetaminophen and in the second group, 15 mg/kg of IV acetaminophen was administered at the end of surgery before extubation. Systolic and diastolic blood pressure and heart rate were measured every 15 minutes after intubation. Face pain score was recorded for every 30 minutes between extubation and discharge from recovery room. The data from both groups were analyzed using SPSS program. Results: All demographic findings (age, gender and weight), the size of used endotracheal tubes, initial heart rate, systolic and diastolic blood pressure were comparable in both groups.The pain intensity was reduced in both groups. But this decrease was more prominent in the group who received IV acetaminophen (P=0.006). The changes in systolic blood pressure were not significant in both groups, as well as the changes in systolic blood pressure in recovery room and the ward. Diastolic blood pressure increased both in the recovery room and the ward. The changes were not significant in the ward; whereas, the changes in diastolic blood pressure in recovery room were statistically significant (P=0.008). Heart rate decreased significantly both in the recovery room (P=0.001) and in the ward (P=0.002). Conclusion: Intravenous acetaminophen is more effective than rectal acetaminophen for attenuating post adenotonsillectomy pain in children.


Adenotonsillectomy, Children, Pain, Acetaminophen

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- Fisher SM.(2000). Postoperative pain management in pediatrics. Br J Perioper Nurse, 10(2), 80- 4.

- Berde CD, Sethna NF.(2002). Analgesics for the treatment of pain in children. N Engl J Med.347(14),1094-103.

- Cass LJ, Howard RF.(1994). Respiratory complications due to inadequate analgesia following thoracotomy in a neonate. Anaesthesia,49(10), 879-80.

- Kost- Byerly S.(2002). New concepts in acute and extended postoperative pain management in children. Anesthesiol Clin North America,20(1),115-35.

- Korpela R, Korvenoja P, Mereloja OA.)1999). Morphine- sparing effect of acetaminophen in pediatric daycase surgery. Anesthesiology, 91(2), 442-7.

- Anderson BL, Van Lingen RA, Hansen TG, Lin YC, Holford NH. (2002).Acetaminophen developmental pharmacokinetics in premature neonates and infants: a pooled population analysis. Anesthesiology, 96(6), 1336-45.

- Birmingham PK, Tobin MJ, Fisher DM, Henthorn TK, Hall SC, Cote CJ. (2001).Initial and subsequent dosing of rectal acetaminophen in children: a 24-hour pharmacokinetic study of new dose recommendations. Anesthesiology, 94,385–9.

- Ronald D. Miller, MD, Lars I. Eriksson, Lee A. Fleisher, MD, Jeanine P. Wiener-Kronish,William L. Young.(2005). Miller’s Anestesialogy, 7th ed. Elsevier, USA, 2731-2732.

- Litalien C, Jacqz-Aigrain E.(2001). Risks and bebefitis of nonsteridal anti-inflammatory drugs in children: A Comparison with paracetamol, Pediatr Drug,3(11),817-58.

- Alhashemi JA, Daghistani MF.(2005). Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on post-tonsillectomy pain in children. Br J Anaesthesia,96(6), 790-5.

- Capicil F,Ingelmo P,Davidson A,Sacchil CA,Milan B(2007). Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children, British Journal of Anesthesia, 100 (2), 251–5.

- Prins SA, et al.(2008). Pharmacokinetics and analgesic effects of intravenous propacetamol vs rectal paracetamol in children after major craniofacial surgery. Paediatr Anaesth,18(7),582-92.

-. Javid MJ, Hajijafari M, Hajipour A, Makarem J, Khazaeipour Z. Evaluation of a low dose ketamine in post tonsillectomy pain re¬lief: a randomized trial comparing intravenous and subcutane¬ous ketamine in pediatrics. Anesth Pain Med. 2012;2(2):85–9.

-Heshmati F,Noruzi neya H,Mahoori A,Gorji Rad M,Evaluation of rectal acetaminophen eefect on pediatric post operaton pain control,2008, Iranian Anesthesiology and intensive care journal,2(63)1-9.

-Oscier Ch, Bosley N, Milner Q.(2007). Paracetamol - A Review of Three Routes of Administration, Update in Anaesthesia, 23,112-114.

Seyedhejazi M, JabbariMoghaddam Y, Rahimi Panahi J , Rezazade Jodi M, Bilajani E, Ghojazade M,,Balkani R, Golzari S(2012). Comparison of intravenous fentanyl and infiltration of bupivacaine and clonidine in decreasing post tonsillectomy pain and complications in children, pharm Sci,18(2):141-149.

Haddadi S,marzban S,Seddigh M,Heidarzadeh A,Parivizi ,Naderi B.(2014)Comparing the duration of anal gesic eefects of intravenous and rectal Acetaminophen following Tonsillectomy in children.anesth pain med,4(1):e13175.

Boroumand P, Zamani MM, Saeedi M, Rouhbakhshfar O, Hos¬seini Motlagh SR, Aarabi Moghaddam F. Post tonsillectomy pain: can honey reduce the analgesic requirements? Anesth Pain Med. 2013;3(1):198–202



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