Post‑adenotonsillectomy analgesia in children: The place of non‑steroidal anti‑inflammatory drugs
Main Article Content
Abstract
Background: Adenotonsillectomy and tonsillectomy are common surgeries carried out in children under 15 years of age with associated significant pains; therefore, adequate post-operative pain management is mandatory to ensure full recovery. Non-steroidal anti-inflammatory drugs(NSAIDs), being cheap and readilyavailable, could be used to achieve this.
Objective: The objective was to determine the effectiveness of post-operative analgesia in these children using NSAIDs – diclofenac sodium/ibuprofen.
Methods: All children admitted for adenotonsillectomy/tonsillectomy in the Ear, Nose and Throat surgery department from April 2016 to March 2017 were recruited. All the patients had diclofenac suppository at 1.5 mg/kg immediate post-operative period and then 12 hourly for 48 h and subsequently ibuprofen oral suspension at 5 mg/kg/dose 8 hourly for 5 days. Swallowing and the time of commencement of oral intake were used as indices to ascertain effective or adequate analgesia. The time of commencement of oral intake both for liquids and solids including the duration of hospital stay was documented and analysed using SPSS software version 20.0. The results were presented using simple statistical tables.
Results: A total of 78 children were recruited, of which only 75 underwent the full study. The age ranged from 11 months to 14.5 years with 47 males and 28 females. The age group of 2.6–4.5 years was the most commonly seen, which constituted 43.59%, whereas 46.67% of these patients commenced oral intake in 0–6 h post-operation. There was no post-operative bleeding recorded. There was a mortality of 3.85%.
Conclusion: NSAIDs at regular intervals offer effective analgesia after adenotonsillectomy and appear to be safe in children.
Downloads
Article Details
The journal grants the right to make small numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
References
1. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: Tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144:S1‑30.
2. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009;28:1‑25.
3. Mattos JL, Robison JG, Greenberg J, Yellon RF. Acetaminophen plus ibuprofen versus opioids for treatment of post‑tonsillectomy pain in
children. Int J Pediatr Otorhinolaryngol 2014;78:1671‑6.
4. IdvallE, HolmC, Runeson I. Pain experiences and non‑pharmacological strategies for pain management after tonsillectomy: A qualitative
interview study of children and parents. J Child Health Care 2005;9:196‑207.
5. Salam MA, Cable HR. Post‑tonsillectomy pain with diathermy and ligation techniques. A prospective randomized study in children and adults. Clin Otolaryngol Allied Sci 1992;17:517‑9.
6. TomaAG, Blanshard J, Eynon‑LewisN, Bridger MW. Post‑tonsillectomy pain: The first ten days. J Laryngol Otol 1995;109:963‑4.
7. Finley GA, MacLaren Chorney J, Campbell L. Not small adults: The emerging role of pediatric pain services. Can J Anaesth 2014;61:180‑7.
8. Murthy P, Laing MR. Dissection tonsillectomy: Pattern of post‑operative pain, medication and resumption of normal activity. J Laryngol Otol 1998;112:41‑4.
9. Constant I, Ayari Khalfallah S, Brunaud A, Deramoudt V, Fayoux P, Giovanni A, et al. How to replace codeine after tonsillectomy in children under 12 years of age? Guidelines of the French Oto‑Rhino‑laryngology – Head and neck surgery society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 2014;131:233‑8.
10. Dorkham MC, Chalkiadis GA, von Ungern Sternberg BS, DavidsonAJ. Effective postoperative pain management in children after ambulatory
surgery, with a focus on tonsillectomy: Barriers and possible solutions. Paediatr Anaesth 2014;24:239‑48.
11. Courtney MJ, Cabraal D. Tramadol vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg 2001;127:385‑8.
12. Peterson K, McDonagh M, Thakurta S, Dana T, Roberts C, Chou R, et al. Drug Class Review: Nonsteroidal Anti‑Inflammatory Drugs. Update 4 Final Report. 1st ed. Oregun Health & Science University, 2010. Available from: http://www.derp.ohsu.edu/about/final‑document‑display.cfm. [Last accessed on 2011 May 06].
13. Walker SM. Pain after surgery in children: Clinical recommendations. Curr Opin Anaesthesiol 2015;28:570‑6.
14. Riggin L, Ramakrishna J, Sommer DD, Koren G. A 2013 updated systematic review & meta‑analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti‑inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 2013;38:115‑29.
15. Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab‑Tafti S, Reid D, et al. Morphine or ibuprofen for post‑tonsillectomy analgesia: A randomized trial. Pediatrics 2015;135:307‑13.
16. Nikanne E, Kokki H, Tuovinen K. Postoperative pain after adenoidectomy in children. Br J Anaesth 1999;82:886‑9.
17. Kavanagh KT, Beckford NS. Adenotonsillectomy in children: Indications and contraindications. South Med J 1988;81:507‑14.
18. Statham MM, Myer CM 3rd. Complications of adenotonsillectomy. Curr Opin Otolaryngol Head Neck Surg 2010;18:539‑43.
19. Ibekwe MU, Onotai LO. Adenoid and tonsil surgeries at the university of Port Harcourt teaching hospital Port Harcourt: A ten year review.
Niger J Otorhinolaryngol 2011‑2015;8:8‑13.
20. Afolabi OA, Alabi BS, Ologe FE, Dunmade AD, Segun‑Busari S. Parental satisfaction with post‑adenotonsillectomy in the developing world. Int J Pediatr Otorhinolaryngol 2009;73:1516‑9.
21. Williams DG, Patel A, Howard RF. Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability. Br J Anaesth 2002;89:839‑45.
22. Conlon JA, Mathews A, O’mathuna DP. Analgesics for postoperative pain after tonsillectomy and adenotonsillectomy in children (Protocol).
Cochrane Database Syst Rev 2015;CD011638.
23. Tawalbeh MI, Nawasreh OO, Husban AM. Comparative study of diclofenac sodium and paracetamol for treatment of pain after adenotonsillectomy in children. Saudi Med J 2001;22:121‑3.
24. Michelet D, Andeu-Gallien J, Bensalah I, Hilly J, Wood C, Nivoche Y. Ameta-analysis of the use of nonsteroidal anti-inflamatory drugs for
pediatr postoperative pain. Anaesth Analg 2012;114:393-406.
25. Hermans V, De Pooter F, De Groote F, De Hert S, Van der Linden P. Effect of dexamethasone on nausea, vomiting, and pain in paediatric
tonsillectomy. Br J Anaesth 2012;109:427‑31.