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Comparing the Efficacy of Paracetamol, Diclofenac, and Ketorolac on Post-Appendectomy Outcomes in Children and Adolescents
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Abstract

urgent surgical intervention and appendectomy until now represent standard treatment for uncomplicated cases of appendicitis. Nausea, vomiting and pain after surgery are the most frequent issues facing patients and affecting patient quality of life and responsible for many cases of readmission after surgery. Ketorolac and diclofenac represent the most commonly prescribed non-steroidal anti-inflammatory used in postoperative setting and they cause many side effects as gastrointestinal, kidney and cardiac adverse effect in addition to increased risk of bleeding. Paracetamol is currently among the most frequently prescribed medication worldwide and it can be used safely for all age groups. This study aimed to compare the analgesic efficacy and safety of paracetamol, diclofenac, and ketorolac when used after appendectomy and to assess their efficacy regarding nausea and vomiting in children and adolescents. A randomized, single-blinded, comparative, observational prospective clinical study was carried out on patients diagnosed with acute appendicitis and assigned for emergent appendectomy between October 2018 to May 2019 in Al- Zahraa Teaching Hospital in Al-Najaf province, Iraq.120 patients were randomly distributed into three groups who received diclofenac sodium suppositories (2mg/kg), IV Paracetamol )15mg/ kg every 6 hr.(, and IV  Ketorolac )0.5mg/ kg( immediately after surgery. All patients were observed for pain, nausea and vomiting and bleeding. Patients received ketorolac had a high percentage of the decrease in pain score between 30 and 60 min. after surgery, while paracetamol was the next and diclofenac sodium was the last. Regarding nausea and vomiting after surgery, ketorolac had higher percentage of the decrease in nausea, vomiting score during first day after surgery followed by diclofenac and paracetamol respectively. The present study also showed that there is no significant difference between groups regarding bleeding after surgery. It is concluded that ketorolac has higher analgesic efficacy compared with paracetamol and diclofenac with no risk of nausea and vomiting and bleeding when used after appendectomy.

Keywords: Postoperative pain, Ketorolac, Diclofenac, Paracetamol, Appendectomy.

 

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This study aimed to determine the possibility of culturing genus Artemia in under laboratory conditions for locally culturing and producing. Different salinity concentrations were used, ranging from 5-40g/l . the results showed that the concentration 30g/l is the best for hatching. This concentration recorded hatching efficiency of 68800 nauplii/g cysts and hatching percentage of 45.86%, while the concentration 5g/l recorded less hatching efficiency and hatching percentage of 20266 nauplii/g and 13.5% respectively . Investigating the effect of salinity on individuals survival and growth using saline concentrations ranging from 30to 100g/l, revealed that the best percentage was 75.00% in the first week with 70g/l, whilst the best rates of

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Publication Date
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Haruki Murakami (1949-present) is a contemporary Japanese writer whose works have been translated into fifty languages and won him plenty of Japanese and international awards. His short stories are well constructed in a weird realistic manner and are mixed with elements of surrealism. His novels and short stories fall under the genre of magical realism. One of the major revolving themes that Murakami wrote about was the haunting feeling of emptiness and disconnectedness in a world which seems to care much for materialism and self-interests.

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