Effects of Prophylactic Rectal versus Oral Acetaminophen on Postoperative Conditions in Pediatric Adenotonsillectomy Patients: A Randomized Clinical Trial

Background: The role of premedication with acetaminophen on postoperative conditions in pediatric patients is not well known. We aimed to assess the effects of prophylactic oral versus rectal acetaminophen on postoperative conditions in pediatric adenotonsillectomy patients. Methods: In a double-blinded randomized clinical trial, 127 children undergoing adenotonsillectomies were randomized to receive either acetaminophen syrup 15 mg/kg (PO group) half an hour before surgery, or acetaminophen suppository 15 mg/kg (PR group) at anesthesia induction. Both groups received dexamethasone 0.1 mg/kg before surgery as an antiemetic and underwent the same general anesthesia management. Postoperative pain was evaluated using the face, legs, activity, cry, consolability (FLACC) scale every 30 min during the first 2 h and every 1 h until 4 h after surgery. Child with a FLACC scale > 3 received rescue medication of acetaminophen syrup 5 mg/kg orally. Results: The two groups were not significantly different with respect to patients’ demographics and anesthesia duration. FLACC scales in each time points were similar to each other between the studied groups. Although total postoperative acetaminophen syrup consumption and percentage of nausea or vomiting were lower in the PR group, the differences were not statistically different. The oral feeding starting time was significantly lower in the PR group in comparison with the PO group (p< 0.01). Conclusion: We conclude that prophylactic rectal administration of acetaminophen at anesthesia induction has several beneficial impacts on postoperative conditions in children undergoing adenotonsillectomies.