Acetaminophen Versus Acetaminophen With Codeine After Pediatric Tonsillectomy

Abstract

Objective: To compare the effectiveness of acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy and adenoidectomy. Study Design: Prospective, randomized, double-blind study. Methods: Fifty-one children ages 3 to 12 years scheduled for outpatient tonsillectomy and adenoidectomy were studied. Patients were randomly assigned to receive acetaminophen or acetaminophen with codeine in unlabeled bottles for postoperative pain control. The Wong-Baker FACES pain rating scale was used to help children quantify their level of pain after surgery. The level of pain, quantity of pain medication required, presence of side effects, and the percentage of a normal diet consumed was recorded for 10 postoperative days. Results: There was no difference (P > .05, all time points) in the level of postoperative pain reported by the parents and children in the two groups. The acetaminophen with codeine group tended to have increased problems with nausea, emesis, and constipation, but these differences did not reach statistical significance. Children in the acetaminophen group consumed a significantly higher percentage of a normal diet on the first 6 postoperative days (P < .05, all time points). Conclusion: There was no difference in the level of pain control provided by acetaminophen and acetaminophen with codeine as measured by the Wong-Baker FACES pain rating scale. Postoperative oral intake was significantly higher in children treated with acetaminophen alone.

Intoxication à la morphine en pédiatrie : un cas clinique

“…Par ailleurs, les dispositifs utilisés pour mesurer les formulations liquides sont L'acétaminophène est souvent utilisé en première intention comme analgésique après une amygdalectomie. Son efficacité pour les enfants âgés de 3 à 12 ans serait équivalente à l'acétaminophène-codéine, mais il présente moins d'effets indésirables 13,14 . Bien qu'il existe des données contradictoires, on recommande ordinairement l'administration régulière d'acétaminophène plutôt qu'au besoin pour diminuer la douleur postopératoire 11,15 .…”

Pain relief after daycase tonsillectomy in children

“…They concluded that induction with propofol significantly diminished emergence delerium after sevoflurane anaesthesia, which is in keeping with our experience. Ketamine has received a mixed review regarding its analgesic efficacy following tonsillectomy [4,5]. In our earlier pilot study a slight increase in sedation was observed without significantly increasing analgesia.…”

“…Firstly, codeine is a prodrug and a significant minority of the UK population are unable to convert this to useful levels of morphine [3]. Secondly, a prospective, randomised double blind study failed to demonstrate any difference in postoperative pain relief between paracetamol alone and paracetamol with codeine in children following tonsillectomy [4].…”

A Review of Tonsillectomy Techniques and Technologies

“…Pain medication should be recommended, and most physicians prescribe either acetaminophen or acetaminophen with codeine postoperatively. 31 Some physicians recommend a soft diet postoperatively, others recommend "diet as tolerated." 10 In our centres we commence the child on firstly on cold ice cream and subsequently on liquid diet.…”