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Effective analgesic between acetominophen + B vitamins vs. acetaminophen

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 Cir Cir 2010;78:400-409

Analgesic efficacy between acetominophen + B

vitamins vs. acetominophen in pediatric
ambulatory surgery
Alfonso Galván-Montaño,* Gerardo Reyes-García,** María de Lourdes Suarez-Roa,***
and Juan Asbun-Bojalil****

Abstract

Background: Analgesics in pediatric ambulatory surgery must be safe and effective. Acetominophen is safe with moder-
ate efficacy; therefore, we searched for other drugs. In preclinical trials, improved efficacy was reported with the combina-
tion of acetaminophen + B vitamins. The aim of this study was to determine the analgesic efficacy of acetaminophen + B
vitamins in pediatric ambulatory surgery.
Methods: We conducted a clinical, comparative, randomized, double-blind study. We included 56 patients who were
divided into four groups of 14 patients for each surgery (circumcision, tonsillectomy, inguinal hernioplasty, orchidopexy).
Half of the patients received acetaminophen + B vitamins, and the remaining patients received acetaminophen alone.
Variables were drugs, visual analogue scale and time of discharge. χ2, Student t-test and analysis of variance (ANOVA)
were used for statistical analysis.
Results: In children who received acetaminophen + B vitamins during the immediate postoperative period, 58% had a
pain score <2 and 89% were discharged with a pain score <1. Both schedules were effective and safe but acetaminophen
+ B vitamins showed a better pain score.
Conclusions: The adjuvant effect of B vitamins was demonstrated with a better pain score during the immediate postop-
erative period and at the time of discharge.

Key words: pain, acetominophen, B vitamins, ambulatory surgery, children.

Introduction same time, the emotional component of pain is greater and

Pain in children differs from that in adults because children
are growing and developing; therefore, they are more labile
to painful stimuli and disturbances of homeostasis. At the
* Subdirección de Pediatría,
** Escuela Superior de Medicina, Instituto Politécnico Nacional,
México, D.F., Mexico
*** División de Investigación Clínica, Hospital General “Dr. Manuel
Gea González”, Secretaría de Salud, México, D.F., Mexico
**** Subdirección de Investigación, Instituto Nacional de Perinatología,
Secretaría de Salud, México, D.F., Mexico
Correspondence:
Alfonso Galván Montaño
Subdirección de Pediatría, Hospital General “Dr. Manuel Gea González”
Calzada de Tlalpan 4800, Col. Sección XVI, Del. Tlalpan
14080 México, D.F., Mexico
Tel: (55) 4000 3040
E-mail: gamagq3@hotmail.com
Received for publication: 10-22-2009
Accepted for publication: 6-17-2010
should be taken into account by healthcare personnel so that
there is no traumatic memory of the pain.1,2
Pain in children began to be studied in recent years,
changing the paradigms that suggested that infants did not
perceive pain and, therefore, did not require analgesic man-
agement. Currently, it is known that from the 10th week of
pregnancy the fetus is capable of perceiving pain.3 It is an
ethical responsibility of healthcare personnel to search for
adequate treatment schemes through clinical trials in order
to prevent children from experiencing pain.
Acute pain is a common adverse stimuli experienced by
children undergoing surgical procedures. Pain is associated
with increased anxiety, somatic symptoms and increased
stress for parents.4 Major advances in pediatric surgery
have been parallel to the discovery of more effective and
safer analgesics, allowing major surgeries from early ages.4
Adequate pain management has allowed the performance of
ambulatory surgery, which decreases hospitalization costs,
infections and early reintegration of the child to the house-
hold, reducing the stress caused by the separation. Anal-
gesics used in pediatric ambulatory surgery must be safe

400 Cirugía y Cirujanos

Acetominophen + B vitamins in pediatric surgery
and effective in controlling pain, allowing rapid recovery
in order to accomplish an early discharge. Acetaminophen
is a safe analgesic with moderate efficiency. The use of
other drugs such as opioids has been ruled out due to their
side effects (respiratory depression, paralytic ileus, vomit-
ing).6 Other proposals have focused on the combination of
acetaminophen with nonsteroidal anti-inflammatory pain
killers such as ketoralac, ibuprofen or diclofenac used in
children who underwent tonsillectomy, reporting increased
analgesic efficacy. However, these have side effects such
as abdominal pain, nausea, vomiting, esophagitis, gastritis,
intestinal bleeding, hematuria and proteinuria.7-10
Neurotropic vitamins may enhance the inhibitory control
of afferent pathways in the dorsal horn of the spinal cord
possibly due to increased synthesis of serotonin. Vitamin
B6 can directly suppress the response of spinal neurons to
nociceptive stimuli and may also increase serotonin in some
areas of the central nervous system. Pyridoxine regulates
the 5-hydroxytryptophan decarboxylase enzyme that can
increase the number of S2 serotonin receptors.11-14
Recent studies have reported the analgesic effect of
neurotropic vitamins (vitamins B1, B6 and B12) in acute
pain.15-17 In a preclinical study conducted by Teran,18 it was
found that when neurotropic vitamins are combined with
acetaminophen the analgesic efficacy is increased. A litera-
ture review found no clinical trials based on the combina-
tion of acetaminophen plus neurotropic vitamins in children
undergoing outpatient surgery. The aim of this study was
to determine the analgesic efficacy of acetaminophen plus
vitamin B complex orally administered pre-and postopera-
tively in pediatric patients undergoing ambulatory surgery.
Materials and Methods
A randomized, controlled, comparative, double-blind, pro-
spective, longitudinal clinical trial was carried out and was
approved by the ethics committee of the hospital and in ac-
cordance with the General Health Law Title II, Chapter l,
Article 17, Section III “research investigation with greater
than minimal risk” and Title II, Chapter III “research on mi-
nors or those unable to give consent” Articles 34-39. These
official norms are in accordance with the Declaration of
Helsinki and guidelines for good clinical practice.
Sample size was 56 pediatric patients. Informed consent
was obtained from all parents or guardians. The patients
were divided into four groups of 14 patients each, for each
type of outpatient surgery (circumcision, tonsillectomy,
hernioplasty and orchidopexy). Among the inclusion crite-
ria were children of both genders between 4 and 12 years
of age, weight according to age (<16 kg and not >32 kg)
and scheduled for ambulatory surgery for any of the follow-
Volume 78, No. 5, September-October 2010 401
ing conditions: inguinal hernia, cryptorchidism, phimosis
and chronic tonsillitis, with no history of prior surgery, no
other nonsurgical disease or allergies to any of the treatment
regimens.
Group A (experimental group, seven patients) received
320 mg of acetaminophen + vitamin B complex (thiamin
100 mg, 100 mg pyridoxine and cyanocobolamine 1 mg)
and group B (control group, seven patients) received only
acetaminophen in the same dose, both by mouth. Stability
of the combination of acetaminophen + vitamin B complex
in its use orally was previously confirmed. Treatment was
randomly assigned.
Independent variables were treatment regimens and de-
pendent variable was the visual analog scale (VAS) of pain
developed by Wong and Baker,19 time of discharge and an-
algesic rescue.
Sample size was calculated based on an expected differ-
ence of 25%, α level of 0.05, and a power of 0.80. We used
the following for statistical analysis: χ2, Student t-test, and
ANOVA for more than two groups. The statistical value to
reject the null hypothesis (Ho) was p <0.05. Randomiza-
tion was used for treatment assignment. Children who were
recruited were familiar with the VAS19 (Figure 1). The chil-
dren fasted for 8 h prior to admission on the day of surgery.
They were placed in the preanesthesia area accompanied by
their parent or guardian. Sixty minutes prior to surgery each
patient was randomly administered the assigned treatment
regimen.
Fifteen minutes prior to being admitted to the operating
room patients were given midazolam 100-150 μg/kg sub-
lingually. IV was placed with 1:1 mixed solution of sodium
chloride 0.9% + 5% glucose at 1500 ml/m2 body surface.
Blood pressure, heart rate, oxygen saturation and tempera-
ture were monitored. Atropine was administered IV at doses
of l0 μg/kg with fentanyl citrate 3 μg/kg initial dose and
1 μg/kg as subsequent doses. At 40 min after the start of
surgery, propofol was administered at 2 mg/kg/body weight
and vecuronium bromide (80 mg/kg body weight). The air-
way was secured with endotracheal intubation or laryngeal
mask, maintaining anesthesia with sevoflurane dial set to
2% and oxygen at 3 L/min. Blood loss was quantified by
weighing the gauze. After surgery, midazolam was admin-
istered 100 to 150 μg/kg/body weight and ondansetron
(0.1 mg/kg/body weight), monitoring heart rate, blood
pressure and pulse oximetry. One parent was requested to
remain with the child until discharge.
The second dose of the assigned treatment regimen was
administered once the child recovered from anesthesia
(Glasgow score between 14 and 15). Simultaneously, the
first postoperative evaluation of the VAS was conducted
and at a 1-h interval the second and third assessment of VAS
was done.

0 1 2 3 4 5
Little more
No pain Little pain
pain
FACE 0-Feel very happy because there is no pain
FACE 1-Only have a little pain
FACE 2-Have a little more pain
FACE 3-Have more pain
FACE 4-Have a lot of pain
FACE 5-Hurts as much as you can imagine although you don’t have to be crying to feel so bad
Choose the person whose pain best describes your pain
Figure 1. Wong-Baker pain scale.
The aspects taken into account in assessing whether the
combination has greater analgesic efficacy included rescue
analgesic and assessment of pain scale over time and at the
time of discharge. Effective analgesic effect was considered
to be χ2 according to the Wong-Baker scale.
Rescue analgesic was considered when the pain scores
were 3 or higher, administering doses of ibuprofen of 5-7
mg/kg per dose. Patient was monitored for the presence of
vomiting or nausea. To evaluate the effectiveness of Drug A
and Drug B over time, pain scales for each type of surgery
were determined. The first measurement was done during
the immediate postoperative period, the second measure-
ment at 1 h and the third measurement at 2 h. The discharge
time is the time between the child’s admission to recovery
and discharge to home. The time to discharge the patient
was determined when the patient was able to accept oral
fluids, with micturition and ambulation without difficulty.
When the above conditions were met, the IV was removed
and instructions were given to those responsible for the pa-
tient (parents or relatives) on home care. An adverse effect
was considered to be any unexpected effect related to the
drug. Data were collected using a data collection sheet and
analyzed with the statistical program SigmaStat v.3.
Results
In the overall study population, Table 1 shows how many
patients were males and females by type of surgery and
402 Cirugía y Cirujanos
Galván-Montaño A et al.
More pain
Much pain Worst pain
treatment. In terms of age with the type of surgery and
treatment, the minimum age recorded was 5 years and the
maximum age was 12 years. The statistical test to evaluate
homogeneity of the population was not significant, which
indicates that there is no variation in different groups with
respect to age (Table 2).
The weight of our study population is shown in Table 3
in relation to the type of surgery and medication adminis-
tered where the groups for hernioplasty, orchidopexy and
circumcision were not statistically significant. For the ton-
sillectomy group, there was a statistically significant differ-
ence seen in weight distribution.
To evaluate the effectiveness of Drug A and Drug B
over time, pain scales were determined for each type
of surgery with the first measurement in the immedi-
ate postoperative period (I), the second measurement
at 1 h (II) and the third measurement at 2 h (III) (Table
4), being statistically significant with p = 0.029. Ad-
ministration of another therapeutic regimen, “rescue
analgesic” (ibuprofen) was used in only one case in the
orchidopexy group with medication B (acetaminophen)
(Table 4).
In the cases of hernioplasty, both treatment schemes
showed similar pain profiles in which the analgesic efficacy
did not increase, although it was maintained for 2 h after
postoperative administration.
In cases of orchidopexy and circumcision, the combina-
tion of paracetamol + B vitamin complex was higher than
paracetamol alone after postoperative administration.
Acetominophen + B vitamins in pediatric surgery

Table 1. Distribution in accordance with gender in relation to type of surgery and

treatment administered
Type of surgery Male Female
Drug A* Drug B** Drug A* Drug B**

Hernioplasty 5 2 2 5
Tonsillectomy 2 2 5 5
Circumcision 7 7 ─ ─
Orchidopexy 7 7 ─ ─
Total 39 17
*Acetominophen + neurotropic vitamins.
**Acetominophen.

Table 2. Relation between age and type of surgery and therapeutic scheme
Age (years)
n = 56
Hernioplasty Orchidopexy Circumcision Tonsillectomy
(n = 14) (n = 14) (n = 14) (n = 14)
Case A** B *** A** B*** A** B*** A** B***

1 12 6 7 9 8 5 9 11
2 10 6 6 6 7 7 6 12
3 6 5 11 12 10 9 10 8
4 11 6 6 8 9 11 8 12
5 6 8 9 12 7 10 9 7
6 12 9 10 6 12 6 10 12
7 12 9 9 6 7 6 10 12
Average (years) 9.8 7.0 8.2 8.4 8.5 7.7 8.8 10.5
Minimum/maximum 6/12 5/9 6/11 6/12 7/12 5/11 6/10 7/12
SD 2.734 1.633 1.976 2.699 1.902 2.289 1.464 2.149
p* 0.182 0.368 0.383 0.202

*Student t-test.
**Acetominophen + neurotropic vitamins.
***Acetominophen.
SD, standard deviation.

In cases of tonsillectomy, both treatments showed bet-
ter analgesic efficacy from the first to the second post-
operative hours following postoperative administration,
although paracetamol + B vitamin complex was superior to
paracetamol alone (Figure 2).
In the evaluation of the VAS during the immediate
postoperative with the different therapeutic regimens and
for different types of surgery, Figure 3 shows that, of the
28 patients taking Drug A (acetaminophen + B complex),
57.1% had a pain scale of <2 and of the 28 children who
took Drug B (acetaminophen), 42.8% had a pain score <2.
The statistical test (χ2) for this first evaluation was p =
0.224 (Figure 3).
Figure 4 shows the evaluation of the first VAS taken dur-
ing the postoperative period depending on the therapeutic
regimen for each type of surgery, observing improvement in
hernioplasty, orchidopexy and circumcision, without being
statistically significant.
Regarding the evaluation of the third VAS with different
therapeutic regimens, it was shown that of the 28 patients
taking Drug A (acetaminophen + B vitamin complex), 89%
had a pain scale of <1, and of the 28 children who took

Volume 78, No. 5, September-October 2010 403

 Galván-Montaño A et al.

Table 3. Data related to weight according to type of surgery and therapeutic scheme

Weight (kg)
n = 56
Hernioplasty Orchidopexy Circumcision Tonsillectomy
(n = 14) (n = 14) (n = 14) (n = 14)
Case A** B*** A** B*** A** B*** A** B***
1 32 28 28 30 24 17 32 32
2 32 20 18 20 31 22 29 32
3 20 22 26 32 32 30 32 20
4 32 19 27 24 32 32 32 32
5 20 32 32 32 21 32 32 25
6 32 32 32 22 32 21 32 32
7 32 32 13 18 23 32 32 32
Media (kg) 28.5 26.4 25.1 25.4 27.8 26.5 31.5 29.2
Minimum/maximum 20/32 19/32 13/32 18/32 21/32 17/32 29/32 20/32
SD 5.855 5.940 7.128 5.855 4.947 6.373 1.134 4.855
p* 0.767 0.794 0.186 0.007
*Student t-test.
**Acetominophen + neurotropic vitamins.
***Acetominophen.

Table 4. Difference in pain scales according to time and in accordance with the therapeutic scheme
for each type of surgery
Hernioplasty Orchidopexy Circumcision Tonsillectomy
Drug A** Drug B*** Drug A** Drug B*** Drug A** Drug B*** Drug A** Drug B***

Case I II III I II III I II III I II III I II III I II III I II III I II III

1 3 2 2 2 2 1 2 1 1 5 2 2 1 0 0 5 1 1 4 1 1 1 1 2
2 2 1 1 5 1 1 5 0 0 3 0 2 0 0 0 1 1 1 3 0 0 2 2 2
3 2 1 1 5 2 2 4 2 2 3 2 0 1 1 0 5 2 2 2 1 1 4 2 2
4 1 1 1 1 2 1 4 0 0 1 0 0 5 1 0 3 0 0 4 2 1 4 2 2
5 0 1 1 1 1 1 5 2 0 2 3* 2 1 1 0 1 1 0 2 2 2 3 2 2
6 1 1 1 1 1 0 2 2 1 3 2 2 3 2 1 5 3 1 3 1 1 4 2 2
7 1 1 0 2 1 1 1 1 0 4 1 1 0 0 0 2 2 2 3 1 0 3 2 2

*Patient who was given rescue anesthesia.

**Acetominophen + neurotropic vitamins.
***Acetominophen.
I. First evaluation in immediate postoperative period. χ2 = 5.404.
II. Second evaluation at 1 h. χ2 = 3.505.
III. Third evaluation at 2 h. χ2 = 4.930, p = 0.029.

Drug B (acetaminophen), 50% had a pain score <1. The the different surgeries, there was no statistical difference
statistical test (χ2) to evaluate the effectiveness of the treat- between treatments (Table 5).
ment regimens at patient discharge was p = 0.029 (Figure Clinical trials reported for pain control in children un-
5). Regarding the evaluation time for patient discharge for dergoing outpatient surgery have been performed mainly

404 Cirugía y Cirujanos

 Acetominophen + B vitamins in pediatric surgery

A B A B
χ2 : ns
10
10

5
5

0
0
0 1 2 0 1 2
0 1 2 0 1 2
No. patients

Hernioplasty
Orchidopexy

A B A B
10 10

* * * * *

5 5

0 0
0 1 2 0 1 2 0 1 2 0 1 2
Circumcision Tonsillectomy
Time (h)
ns = nonsignificant * χ , p < 0.05
2
> 2 Moderate-Severe < 2 Light-Moderate

Figure 2. Time course of pain with both therapeutic schemes according to surgery.

30 on tonsillectomies.20-22 However, at present the frequency

of other types of surgeries has increased with circumcision,
hernioplasty and orchidopexy being among the most com-
mon and in which tissue damage and the degree of pain is
20
different. This study covered the four most frequently per-
No. patients

formed outpatient surgeries in children at the Hospital “Dr.

Manuel Gea Gonzalez” in order to evaluate the efficacy of
10 a new therapeutic regimen consisting of acetaminophen +
57.1% 42.8% neurotropic vitamins.
(15/28) (12/28) Administration of the selected therapeutic regimen was
0
oral because it is well tolerated by all patients. It is less
A B invasive and better tolerated than rectal administration, as
reported in the literature.23,24
Another important point considered in this study was the
> 2 Moderate-Severe < 2 Light-Moderate emotional component of pain, based on the particular func-
tional learning history for each individual where pain is re-
ported in situations where “objectively” it should not occur.
Figure 3. Differences in the evaluation of the first visual pain scale It is an obvious fact that all measurements up to that point
during the postoperative period, followed by the therapeutic scheme. do not objectively discriminate among pain, anxiety or fear.

Volume 78, No. 5, September-October 2010 405

 Galván-Montaño A et al.

10 10
>2
<2

5 5
6/1 5/2

3/4 2/5
0 0
A B A B
No. patients

Hernioplasty Orchidopexy

10 10

5 5

5/2 3/4
0
0
A B A B
Circumcision Tonsillectomy

> 2 Moderate-Severe < 2 Light-Moderate

Figure 4. Differences in the evaluation of the first visual pain scale during the postoperative period, followed by the therapeutic scheme for
each type of surgery.

30 The emotional component as reported by Cardona-

Duque25 is very strong in children and may be a bias in as-
sessing the pain scale. For this reason, children without any
previous history of surgery were included and the presence
20 89% of parents accompanying their child was requested in the
No. patients

(25/28)
recovery area to prevent anxiety or fear.
Pain assessment using the VAS proposed by Wong and
10 50% Baker19 in 1988 was widely understood by all children in-
(14/28) cluded in this study regardless of age. Its ease of application
and acceptance by children of different ages justifies its use
0 as a routine tool in our institution.
A B In the literature, clinical trials for pain control in children
performed by Breivik,26 Morton,27 and Matthews28 are based
χ2 , p = 0.029 (significant) < 1 Light-Moderate on a combination of acetaminophen with NSAIDs (ibuprofen,
ketoralac, diclofenac) with satisfactory results in controlling
pain. However, the main limitation to its implementation as a
Figure 5. Differences in the evaluation of the third visual pain scale treatment scheme are its collateral effects.9,10 Other preclini-
with different therapeutic schemes. cal studies have been based on the combination of B vitamin

406 Cirugía y Cirujanos

Acetominophen + B vitamins in pediatric surgery

Table 5. Time of discharge (min) in different surgeries with different

therapeutic schemes administered
Hernioplasty Orchidopexy Circumcision Tonsillectomy
(n = 14) (n = 14) (n = 14) (n = 14)
Case A** B*** A** B*** A** B*** A** B***

1 195 170 160 205 115 175 250 180

2 205 155 200 230 100 200 155 140
3 260 150 200 160 180 165 155 155
4 215 225 175 120 170 240 125 185
5 245 195 185 205 215 180 225 185
6 190 220 170 270 160 255 170 175
7 165 210 230 150 270 130 180 185
Median (min) 210.7 189.2 188.5 191.4 171.4 198.5 181.4 170.7
SD 32.714 31.015 23.579 59.553 58.361 41.504 43.274 17.182
*p 0.232 0.233 0.489 0.496 0.336 0.338 0.554 0.560

*Student t-test.
**Acetominophen + neurotropic vitamins.
***Acetominophen.
SD, standard deviation.

complex and different analgesics such as those performed by
Brüggemann,29 Lettko and Bartoszyk30 Reyes-Garcia et al.31
among others, reporting an increase in analgesic efficacy.
There were two multicentric, randomized, double-blind stud-
ies reported in the literature, one by Schwieger et al.32 and
the other by Lettko et al.33 Comparing the use of diclofenac
vs. diclofenac + neutropic vitamins for lower back problems,
radicular pains, and rheumatoid arthritis found a decrease in
pain and treatment time for the combination, confirming a
potentiation of the analgesic effect of diclofenac.
Another preclinical study performed by Teran-Rosales
et al.18 reported the combination of neurotropic vitamin B
complex with acetaminophen or metamizol administered
orally for pain caused by formalin test in rats. Results
showed synergy using both combinations; thus, its useful-
ness for the management of inflammatory pain is proposed.
A review of the literature found no references to trials that
used one of these combinations for postoperative pain man-
agement in children. However, the importance of this work
can be considered pioneer and the results obtained as the
basis for other clinical trials.
The aspects taken into account in assessing whether the
combination of drugs has greater analgesic efficacy includ-
ed rescue analgesic, assessment of pain scale over time and
time of discharge. In the administration of the rescue anal-
gesic, another therapeutic rescue approach (ibuprofen) was
used in only one case of orchidopexy in group B with medi-
cation (acetaminophen), concluding at this point that both
treatments were effective. Children maintained postopera-
tive pain scores between 0 and 2 until they were discharged.
All patients were discharged prior to 4 h, and no patient
was hospitalized, with the conclusion that both treatments
were effective. The third and most important point to evalu-
ate the efficacy of treatments used was the measurement
of pain scores obtained over time for different therapeutic
regimens and surgery group. Three measurements were
made: one during the immediate postoperative period con-
sidered as time zero, at 1 h, and the third measurement
at 2 h, at which time the patient was discharged. Farrat34
mentioned that pain is subjective and pain measurement
depends on verbal report of the patients. Therefore, results
on the pain scale are difficult to interpret and their clinical
significance is not obvious. Pain scale measurements can
also be interpreted differently by clinicians and researchers
depending on the criteria applied. In our study we consid-
ered effectiveness when a pain score was maintained at <2
from the first administration of medication (acetaminophen
+ vitamin B complex, or acetaminophen) in the immediate
postoperative period until discharge. The results showed no
statistically significant difference between treatment regi-
mens, which can be interpreted to mean that both therapeu-
tic regimens were effective for different types of surgery
because pain scores remained <2. Acetaminophen was ef-
fective individually for acute pain control in children under-
going outpatient surgery procedures such as circumcision,
hernioplasty, orchidopexy and tonsillectomy, taking into
consideration these were children with no prior surgeries
and, therefore, there was no emotional component of pain.
The adjuvant effect of the vitamin B complex was ob-
served during the first postoperative pain scale measure-

Volume 78, No. 5, September-October 2010 407


ment in the immediate postoperative period where 58% of
children who received therapeutic regimen A (acetamino-
phen + B complex vitamins) had pain scales <2 compared
to 42% who received the therapeutic scheme B (acetamino-
phen), and 89% of children who received therapeutic regi-
men A were discharged with a pain scale of <1 compared to
11% with Drug B. Although statistically not significant, our
p value was very close to that proposed, which may suggest
that the vitamin B complex potentiates the analgesic effect
of acetaminophen. In this study there were no adverse reac-
tions attributable to acetaminophen or vitamin B complex,
considering both drugs as safe.
In conclusion, effective analgesia was considered to be
expressed statistically (χ2) according to the Wong-Baker
scale:
1) Schemes with paracetamol alone or in combination
with vitamin B complex are equally effective for pain
relief in pediatric patients undergoing ambulatory
surgery and according to the need for rescue and dis-
charge, as well as being safe in regard to frequency of
adverse events.
2) Children who received B complex vitamins (B1, B2
and B6) had better scores during the immediate postop-
erative period and upon discharge.
3) The combination of paracetamol with B complex vi-
tamins in the proposed scheme showed greater overall
analgesic activity in cases of circumcision and orchido-
pexies.
4) The combination of paracetamol with B complex vita-
mins appears to be a better analgesic alternative than
paracetamol alone in pediatric ambulatory surgery.
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