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

• Published in: Clinical otolaryngology Vol. 41; no. 6; pp. 660 - 665
• Main Authors: Syed, M.I., Magos, T.A., Singh, J., Montague, M.L.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Acetaminophen - therapeutic use; Adenoidectomy - adverse effects; Analgesics - therapeutic use; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Ibuprofen - therapeutic use; Male; Morphine - therapeutic use; Pain; Pain Management; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pilot Projects; Prescription drugs; Prospective Studies; Scotland; Tonsillectomy - adverse effects
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.12579

Objective The objective was to ascertain the efficacy of a new analgesic regimen introduced in children undergoing (adeno)tonsillectomy in view of the ban on codeine use in children <12 years by the European Medicines Agency (EMA) and UK Medicines and Healthcare Products Regulatory Agency (MHRA). Design Prospective pilot study at a paediatric tertiary referral centre. Materials and methods A total of 176 children undergoing (adeno) tonsillectomy over a 5‐month period (Sept 2013‐Jan 2014) were included in the study. Data were prospectively collected on analgesia used peri‐operatively and patients were discharged on regular paracetamol and ibuprofen for 7 days and three doses of oral morphine sulphate solution to be used on days 3, 4 and 5. Pain scores were recorded on days 1–10 post‐operatively using the Wong Baker Faces Pain Rating scale. Results The pain scores were significantly better (P‐value < 0.0001) in children who were compliant with morphine (n = 93) than those who were not (n = 32). We also found that children who were compliant with morphine were less likely to seek help out of hours (P‐value < 0.001). Conclusions Oral morphine sulphate solution provides a reasonable alternative to codeine, albeit one should bear in mind that parental concerns and adverse effects of the drug were seen in a minority of patients (n = 11) and anaesthetists were reluctant to prescribe the drug in cases of severe OSA or associated central apnoeas (n = 7).