Does diclofenac relieve tonsillectomy pain better than paracetamol, and does it increase bleeding?

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Diclofenac is widely used for postoperative pain relief, but its safety around surgery is controversial because its effect on platelet aggregation might increase blood loss. This prospective, investigator-blinded study compared diclofenac and paracetamol for pain and blood loss in patients undergoing tonsillectomy.

Ninety patients were randomised to receive rectal diclofenac at 0.65–1.0 mg/kg or paracetamol at 13–20 mg/kg before surgery. Ten patients were excluded after randomisation. Postoperative pain was assessed using the visual analogue scale and by recording pethidine use for rescue analgesia. Perioperative blood loss was assessed through measured intraoperative blood loss, use of drugs to achieve haemostasis, and the incidence of reoperations.

Anaesthetic and surgical management did not differ between groups, but surgery lasted significantly longer in the diclofenac group: 32 ± 16 versus 25 ± 11 minutes in the paracetamol group (P = 0.024). Neither pain scores nor pethidine consumption differed significantly between groups. Intraoperative blood loss was significantly greater with diclofenac: 1.9 (1.1–3.1) versus 1.1 (0.7–2.0) ml/kg with paracetamol (P = 0.007).

The study concluded that preoperative rectal diclofenac offers no advantage over paracetamol for postoperative analgesia in tonsillectomy patients but increases intraoperative blood loss.