Related Experiment Video

Updated: Mar 31, 2026

CO2-Lasertonsillotomy Under Local Anesthesia in Adults
05:07

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

Published on: November 6, 2019

26.9K

A new analgesia regimen after (adeno) tonsillectomy in children: a pilot study

M I Syed1, T A Magos1, J Singh2

  • 1Royal Hospital for Sick Children, Edinburgh, UK.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|November 1, 2015
PubMed

Insights

This study evaluated a new pain management plan for children after tonsillectomy, finding that compliant use of oral morphine sulphate significantly improved pain scores and reduced the need for urgent care. This offers a viable alternative to codeine for pediatric pain relief.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • The European Medicines Agency (EMA) and UK Medicines and Healthcare Products Regulatory Agency (MHRA) have restricted codeine use in children under 12.
  • Tonsillectomy is a common pediatric surgical procedure associated with significant post-operative pain.
  • Alternative analgesic strategies are needed for effective pain management in this population.

Purpose of the Study:

  • To assess the efficacy of a novel analgesic regimen in children undergoing (adeno)tonsillectomy.
  • To provide an alternative pain management strategy following regulatory restrictions on codeine.
  • To evaluate pain scores and healthcare utilization in children receiving the new regimen.

Main Methods:

  • A prospective pilot study was conducted at a pediatric tertiary referral center.
  • 176 children undergoing (adeno)tonsillectomy were enrolled.
  • The regimen included regular paracetamol and ibuprofen, with scheduled oral morphine sulphate on days 3, 4, and 5 post-operatively. Pain was assessed using the Wong Baker Faces Pain Rating scale from days 1-10.

Main Results:

  • Children compliant with oral morphine sulphate demonstrated significantly better pain scores (P < 0.0001).
  • Compliance with morphine was associated with a significantly lower likelihood of seeking out-of-hours help (P < 0.001).
  • Parental concerns and adverse effects were reported in a minority of patients (n=11).

Conclusions:

  • Oral morphine sulphate solution serves as a reasonable alternative analgesic to codeine for pediatric post-tonsillectomy pain.
  • Careful consideration is needed regarding parental concerns and potential adverse effects.
  • Anesthetists expressed reluctance to prescribe morphine in cases of severe obstructive sleep apnea (OSA) or central apneas (n=7).
Abstract

More Related Videos

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas07:43

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

20.1K
Guidelines for Elective Pediatric Fiberoptic Intubation11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

18.9K

Related Concept Videos

Tonsillitis II: Management01:26

Tonsillitis II: Management

This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.
567
Chronic Pharyngitis01:23

Chronic Pharyngitis

Chronic pharyngitis refers to persistent inflammation of the pharyngial mucosa.
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
15.0K
Tonsillitis I: Introduction01:30

Tonsillitis I: Introduction

Tonsillitis is inflammation of the tonsils, which are two lymphoid tissue masses at the back of the throat. This condition can cause discomfort and irritation in the throat.
Etiology
Three primary contributing factors have been identified.
3.2K
Suctioning the Nasopharyngeal Airway01:29

Suctioning the Nasopharyngeal Airway

Nasopharyngeal suctioning is a procedure to remove secretions from the upper part of the respiratory tract that the patient cannot clear independently. It helps maintain airway patency and prevents complications such as aspiration pneumonia.
Equipment Required
5.3K
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy

Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
1.0K
Acute Pharyngitis01:30

Acute Pharyngitis

Introduction
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
5.8K