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Tonsillectomy is a common surgical procedure performed in children. Codeine usage in children was severely restricted in 2013.
Accordingly to the
most recent guidelines, pain management after tonsillectomy could combine
acetaminophen (A) with ibuprofen (I) or tramadol (T). Therefore, in this
research author revealed that A + I seems at least as capable as the
combination A + T, without increasing readmission and additional surgery for
bleeding.
Tonsillectomy is a common surgical procedure performed in
children. Codeine usage in children was severely restricted in 2013. The French
guidelines for treating tonsillectomy's postoperative pain at home have been
reconsidered.
Our study aimed to measure the effectiveness and safety of two schedules, i.e.
Acetaminophen + Ibuprofen (A + I) and Acetaminophen + Tramadol (A + T) in
children who had tonsillectomy.
This is a 1 year prospective and observational
single-center study considering children who underwent tonsillectomy. The
option of the regimen, A + I group or A + T group, was done by the
anesthesiologist in charge during the pre-anesthetic examination. After the
hospital discharge, parents had to give systematically A + I or A + T, 4 times
daily during 5 days and then,acetaminophen alone for the next 5 days. The
primary endpoint was the home pain examined using the Parents' Postoperative
Pain Measurement Short Form (PPPM-SF) scale. Secondary endpoints comprised of
rate of further hospitalization and/or surgery because of tonsillectomy-related
adverse events.
Three hundred and fourty two tonsillectomies were
performed during the study period. Return rate of PPPM-SF scales was 58%. Total
200 patients were investigated. Median age was 4 years and was lower in group
A + I (4 [3; 5]; 5 [4; 7]; p < 0.0001). PPPM-SF scores were higher than or
equal to 3 in both the groups during the first 6 postoperative days. The mean
decrease of PPPM-SF score with time was higher in group A + I as compared to
group A + T (p = 0.007). Readmission rate was notably higher in A + T group (A + I: 0; A + T: 7; p = 0.002) as the rate
of reoperation for bleeding (A + I: 0; A + T: 3; p = 0.049).
After tonsillectomy, the home pain management should be
improved. A + I appears to be least as effective as the combination A + T and,
without increasing readmission and/or additional surgery for bleeding in the
clinical practise.
Eur Arch Otorhinolaryngol. 2018 Jan;275(1):281-286
Pain after tonsillectomy: effectiveness of current guidelines?
Walrave Y et al.
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