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Published on: November 6, 2019
Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency
Joshua R Bedwell1, Matthew Pierce2, Michelle Levy3
1Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC, USA jbedwell@childrensnational.org.
Insights
Ibuprofen and acetaminophen are a safe alternative to codeine for pediatric tonsillectomy pain. Both pain management options showed similar rates of emergency department visits for dehydration.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Pharmacology
Background:
- Postoperative pain management after tonsillectomy is crucial for pediatric patients.
- Codeine has been a traditional choice, but concerns about efficacy and side effects exist.
Purpose of the Study:
- To compare the effectiveness of ibuprofen plus acetaminophen versus codeine plus acetaminophen for managing pain and dehydration after pediatric tonsillectomy.
- To assess the need for emergency department (ED) visits or hospital admissions for pain or dehydration.
Main Methods:
- Retrospective case series involving patients who underwent tonsillectomy with or without adenoidectomy.
- Patients were grouped based on postoperative pain management: acetaminophen with codeine or acetaminophen with ibuprofen.
- Primary outcome was the proportion of patients requiring ED visits or inpatient admission for inadequate pain control or dehydration.
Main Results:
- No significant difference was found in the proportion of patients requiring ED visits or inpatient admission for dehydration between the ibuprofen and codeine groups (2.7% vs 5.1%, P = .12).
- Patients receiving codeine plus acetaminophen were more likely to use antibiotics postoperatively (50.3% vs 5.9%).
- No significant differences were observed in secondary outcomes, including postoperative hemorrhage or return to the operating room.
Conclusions:
- Ibuprofen combined with acetaminophen is a safe and effective analgesic option for pediatric tonsillectomy patients.
- This combination offers a viable alternative to codeine-based pain management in this population.
Objective:
To compare the performance of ibuprofen vs codeine for postoperative pain management after tonsillectomy as measured by need for emergency department (ED) treatment for pain and/or dehydration.
Study Design:
Retrospective case series with chart review.
Setting:
Tertiary children's hospital.
Subjects And Methods:
Consecutive series of patients who underwent tonsillectomy with or without adenoidectomy at a tertiary children's hospital. Patients were categorized based on the type of postoperative pain management (acetaminophen with codeine vs acetaminophen and ibuprofen). The main outcome measure was the proportion of patients requiring ED visits or inpatient admissions for inadequate pain control or dehydration. Secondary measures included antibiotic use, postoperative hemorrhage, need for return to the operating room, vomiting, and oral diet tolerance.
Results:
Patients in the ibuprofen/acetaminophen group were younger than those in the codeine/acetaminophen group (6.2 vs 8.1 years, P < .05). Patients in the codeine/acetaminophen group were more likely to use antibiotics in the postoperative period (50.3% vs 5.9%, P < .05). The proportion of patients requiring ED visits or inpatient admission for dehydration was not significantly different between the groups (5.1% for codeine, 2.7% for ibuprofen, P = .12). Multivariable analysis controlling for age and antibiotic use showed no difference in ED visits or admission for dehydration (P = .09). There was no difference between the groups for any of the secondary measures.
Conclusions:
Ibuprofen with acetaminophen represents a safe and acceptable analgesic alternative to codeine and acetaminophen in patients undergoing pediatric tonsillectomy.
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