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Randomized clinical trial of non-opioid pain medications after intracapsular adenotonsillectomy
Nathan E Lu1, Amber D Shaffer1, Marina V Rushchak1
1Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Non-opioid pain control is safe and effective for children undergoing intracapsular adenotonsillectomy (T&A). This study found similar pain scores and outcomes between non-opioid and opioid groups, supporting non-opioid management.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Anesthesiology
Background:
- Intracapsular adenotonsillectomy (T&A) pain management often involves opioids.
- The safety and efficacy of non-opioid pain control following T&A require further investigation.
Purpose of the Study:
- To determine if non-opioid pain control is safe and effective for children after intracapsular T&A.
Main Methods:
- A randomized, open-label trial compared non-opioid management (ibuprofen/acetaminophen) with opioid management (oxycodone + ibuprofen/acetaminophen) in children aged 3-17 undergoing intracapsular T&A.
- Primary outcome: Wong-Baker FACES pain scores (post-op days 0-14). Secondary outcome: Emergency department (ED) visits.
Main Results:
- No significant difference in average pain scores between the non-opioid and opioid groups before or after analgesics.
- Low rates of oxycodone use in the opioid group; no patients in the non-opioid group requested opioids.
- Similar outcomes regarding peak pain, analgesic duration, ED visits, and caregiver satisfaction between groups.
Conclusions:
- Non-opioid pain management, including ibuprofen and acetaminophen, is appropriate and effective for children undergoing intracapsular T&A.
- Achieved low pain scores, comparable to previous reports using different T&A techniques.
Background:
Our purpose was to determine if non-opioid pain control is safe and effective in the treatment of pain following intracapsular adenotonsillectomy (T&A).
Methods:
A randomized, open-label, controlled trial of children ages 3-17 undergoing intracapsular T&A was conducted at a tertiary children's hospital April 2021-May 2023. Exclusions were concomitant procedures, Down syndrome, coagulopathy, craniofacial anomalies, and current opioid use. Participants were randomized to receive a prescription for oxycodone (opioid group) or not (non-opioid group). All patients received ibuprofen/acetaminophen. The primary outcome, average Wong-Baker FACES pain scores on post-operative days 0-14, was compared between groups using t-tests. The secondary outcome, emergency department (ED)/urgent care visits, was compared using logistic regression.
Results:
Age (median 4, range 3-12) and gender (42/70, 60 % male) were similar in both groups. Pain diaries were returned by 21/36 (58 %) in the opioid group and 23/34 (68 %) of the non-opioid group. Average pain was not different between groups before (opioid: mean 3.2, 95 % CI 2.5-3.8; non-opioid: mean 3.3, 95 % CI 2.5-4.0) or after (opioid: mean: 1.1, 95 % CI 0.6-1.5; non-opioid mean: 1.0, 95 % CI 0.5-1.5) analgesics. Only 7/21 (33 %) of the opioid group took ≥1 dose of oxycodone; no patients in the non-opioid group requested an opioid prescription. There were no differences in peak pain scores, duration of analgesic use, ED/urgent care visits, or caregiver-reported symptoms or satisfaction between groups.
Conclusions:
Pain scores were low compared with previous reports in children undergoing extracapsular T&A, suggesting non-opioid management is appropriate for pain control in this population.
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