Diclofenac and flurbiprofen with or without clonidine for postoperative analgesia in children undergoing elective ophthalmological surgery

We conducted a prospective, randomized study to compare the efficacy of preoperative diclofenac, flurbiprofen, and clonidine, given alone, as well as the combination of diclofenac and clonidine, and flurbiprofen and clonidine in controlling postoperative pain in 125 children. The patients (ASA I, 2–12 years) undergoing elective ophthalmological surgery were allocated to one of five groups: rectal diclofenac 2 mg·kg –1 following oral placebo premedication, i.v. flurbiprofen 1 mg·kg –1 following placebo premedication, oral clonidine premedication, rectal diclofenac 2 mg·kg –1 following clonidine, and i.v. flurbiprofen 1 mg·kg –1 following clonidine. The children received clonidine (4 μg·kg –1 ) or placebo 105 min before anaesthesia. Diclofenac or flurbiprofen was given immediately after induction of anaesthesia. Anaesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Postoperative pain was assessed by a blinded observer using a modified objective pain scale (OPS). No opioids were administered throughout the study. Rectal diclofenac 2 mg·kg –1  i.v. flurbiprofen 1 mg·kg –1 , oral clonidine 4 μg·kg –1 provided similar OPS scores and requirement for supplementary analgesics during 12 h after surgery. Combination of oral clonidine and one of these nonsteroidal analgesics minimized postoperative pain. Our findings suggest that this combined regimen may be a promising prophylactic approach to postoperative pain control in children undergoing ophthalmological surgery.