Pre-emptive vs Preventive Paracetamol for Perioperative Analgesia: A Prospective Randomised Study to Evaluate the effect of Timing of Drug Administration on Perioperative Pain Management in Paediatric Patient

Background: Effective peri-operative pain control in children is essential to reduce stress responses, improve recovery, and prevent chronic pain development. Pre-emptive analgesia differs from preventive analgesia as it aims to attenuate central sensitization by administering analgesics before surgical stimulus. Intravenous (IV) paracetamol is widely used for paediatric analgesia, but the optimal timing of administration—pre-emptive versus preventive—remains uncertain. This study aimed to compare the efficacy of pre-emptive and preventive IV paracetamol in paediatric patients undergoing surgeries under general anaesthesia. Material and Methods: The study was conducted on 50 children aged 4–14 years, classified as American Standard of Anaesthesiologist (ASA) grade I–II, undergoing elective surgeries. Patients were allocated into two groups: Group PE received IV paracetamol 15 mg/kg 15 minutes before induction, while Group PV received the same dose after surgical closure. Postoperative pain was assessed using the Wong–Baker FACES Pain Rating Scale. Rescue analgesia, side effects, C-reactive protein levels and parental satisfaction were also recorded. Data were analysed using appropriate statistical tests, with p < 0.05 considered as significant. Results: Demographic and surgical variables were comparable between groups. The mean time to first rescue analgesia was longer in the pre-emptive group (128.85 ± 60.68 min), compared with the preventive group (118.57 ± 32.91 min) and the difference was statistically significant (p = 0.03). At one hour, mean pain scores were significantly lower in the pre-emptive group (2.20 ± 2.48) than in the preventive group (5.68 ± 3.94; p < 0.001). Cumulative 24-hour pain scores were also lower in Group PE (6.36 ± 5.89 vs. 15.32 ± 8.63; p = 0.001). Adverse effects were minimal and comparable. Parental satisfaction was higher in Group PE (4.48 ± 0.51 vs. 3.92 ± 0.64; p = 0.001). Conclusion: Pre-emptive IV paracetamol provides superior analgesia, reduces additional analgesic needs, and improves parental satisfaction compared to preventive dosing, with minimal adverse effects. It is a safe and effective component of multimodal paediatric pain management.

Keywords: Pre-emptive analgesia, c, Intravenous paracetamol, Postoperative pain, Paediatric surgery.