A Comparative Study of the Analgesic Effects of Pethidine versus Ketorolac and Acetaminophen after Lower Abdominal and Genital Surgeries in Children

Background: For postoperative pain control, numerous methods and medications have been suggested, such as non-steroidal anti-inflammatory drugs (NSAIDs) and narcotics. Pethidine, as a narcotic analgesic, and ketorolac as an NSAID and acetaminophen, are widely used for pain control. In this study, the effect of ketorolac and acetaminophen on postoperative pain was compared with pethidine in the lower abdominal and genital surgeries in children. Methods: In a double-blind randomized clinical trial study, 64 children undergoing lower abdominal and genital surgeries were selected and randomly divided into 2 groups. At the end of the surgery and before extubation, the first group received 10-15 mg/kg acetaminophen suppository and 0.5 mg/kg intravenous ketorolac and the second group received 1 mg/kg intravenous pethidine. Postoperative pain [using Objective pain scale (OPS)] and complications were evaluated and compared until 24 hours after the surgery. Findings: Postoperative pain relief was similar in the two groups up to half an hour (OPS of 5.38 ± 1.93 vs. 5.44 ± 2.04); but, from 1 to 24 hours postoperatively, pain scores were significantly higher in the pethidine group (P < 0.05). In addition, the occurrence of nausea and vomiting was similar in both groups (P > 0.05). No other complication was observed in the patients. Conclusion: Ketorolac and acetaminophen are two frequently used non-opioid analgesics that may be used in combination for effective pain control after surgical procedures in children.