Alternating Doses of Ibuprofen and Acetaminophen Provided an Effective Treatment for Pain Relief After Tonsillectomy in Children

Alternating doses of ibuprofen and acetaminophen provided an effective treatment for post-tonsillectomy pain in the majority of children and did not increase rate of bleeding.The new finding appear in Annals of Otology, Rhinology & Laryngology. Pain control after tonsillectomy in children is critical for a good quality of postoperative recovery. Opioids, acetaminophen and non steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management following tonsillectomy in the pediatric population. While opioids are effective in controlling postoperative pain, opioids’ adverse effects such as sedation, respiratory depression, nausea, emesis, pruritus, and constipation limit their use. Moreover, the use of codeine, an opioid analgesic, was associated with fatality after tonsillectomy in children with obstructive sleep apnea. Consequently, the US Food and Drug Administration and European Medicines Agency issued a contraindication on codeine use in children undergoing tonsillectomy and/or adenoidectomy. A variety of NSAIDs has been shown to be effective for post-tonsillectomy analgesia by reducing or eliminating the need for opioids. Concerns for increased bleeding rate made practitioners reluctant to use NSAIDs in patients undergoing surgery. The American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline regarding tonsillectomy included ibuprofen as an option for pain management. Recently, ibuprofen with acetaminophen was suggested as a safe alternative to codeine with acetaminophen. The aims of the present study were to determine the outcomes of alternating doses of ibuprofen and acetaminophen in treatment of post tonsillectomy pain in children and to identify characteristics of children who had inadequate pain control. In this Study, the medical records of children who received alternating doses of ibuprofen and acetaminophen for post tonsillectomy pain between August 2012 and November 2013 at a tertiary care children’s hospital were reviewed. Incidences of postoperative bleeding and unresolved pain were determined. A total of 583 patients (304 males, 279 females, age range =1-18 years) had received alternating doses of ibuprofen and acetaminophen after tonsillectomy and adenoidectomy. Of the 583 patients, 56 (9.6%) reported inadequate pain control. Age, sex, obesity, presence of comorbid conditions, indications for surgery, and concurrent surgical procedures were not different between children who had adequate analgesia and children who had unresolved pain. Twenty-four patients (4.1%) had postoperative bleeding. Nine patients (1.5%) required surgical intervention for bleeding.The results of this study have been accepted for presentation at the American Society of Pediatric Otolaryngology, April 22-26, 2015, Boston, Massachusetts. So, children taking alternating doses of ibuprofen and acetaminophen provided an effective control of post-tonsillectomy pain in the majority of children and did not increase the rate of bleeding. Sex, obesity, indications for surgery, and concurrent surgical procedures did not affect the need for additional analgesic. Alternating Doses of Ibuprofen and Acetaminophen Provided an Effective Treatment for Pain Relief After Tonsillectomy in Children