Ketoprofen and tramadol for analgesia during early recovery after tonsillectomy in children

Abstract

A dose of 4 mg.kg(-1) of i.v. ketoprofen provided good pain relief with moderate supplemental PCA-fentanyl requirements during the first six postoperative hours after tonsillectomy in children whereas the effects of 2 mg.kg(-1) of i.v. tramadol did not differ from those of placebo.

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…Many studies for post-tonsillectomy pain have low sensitivity and tramadol has been variably reported to be more effective than low-dose paracetamol (Pendeville et al, 2000 Level II), have similar efficacy to morphine (Engelhardt et al, 2003 Level II), and be less effective than pure agonist opioids (Ozer et al, 2003 Level II;Ozalevli et al, 2005 Level III-1) or ketoprofen (Antila et al, 2006 Level II). Further controlled trials are required to determine the role and optimum dose of tramadol in children.…”

“…Fentanyl PCA has been used safely and effectively following neurosurgery (Chiaretti et al, 2008 Level IV), thoracic surgery (Butkovic et al, 2007 Level III-1) and tonsillectomy (Antila et al, 2006 Level II), and for acute cancer-related pain (Ruggiero et al, 2007 Level IV). In comparison with morphine, tramadol PCA provided minor improvements in time to extubation post cardiac surgery Level II) and reduced nausea post-tonsillectomy but at the cost of higher pain scores (Ozalevli et al, 2005 Level II).…”

“…Rapid redistribution contributes to offset of action, fentanyl is metabolised by CYP3A4 to inactive metabolites, and clearance is only 70-80% of adult levels in neonates but rapidly matures (Tibboel et al, 2005). Fentanyl has been administered by multiple routes for perioperative pain management in neonates (Simons & Anand, 2006) and children , including: IV infusion or PCA (Antila et al, 2006 Level II; Butkovic et al, 2007 Level III-1); intrathecal (Batra et al, 2008 Level II) injection; epidural infusion (Lerman et al, 2003 Level II) and patient-controlled epidural analgesia (PCEA) (Saudan et al, 2008 Level III-3). Prolonged IV infusion of fentanyl during neonatal intensive care has been associated with more rapid dose escalation than morphine, but both can produce opioid withdrawal symptoms following rapid cessation (Simons & Anand, 2006).…”

“…Combining nsNSAIDs and paracetamol has been shown to improve analgesia and/or decrease the need for additional analgesia after adenoidectomy (Viitanen et al, 2003 Level II), tonsillectomy (Pickering et al, 2002 Level II), inguinal surgery (Riad & Moussa, 2007 Level II), multiple dental extractions (Gazal & Mackie, 2007 Level II), and orthopaedic surgery (Hiller et al, 2006 Level II). As a component of multimodal analgesia, nsNSAIDs decrease opioid consumption (Antila et al, 2006 Level II; Rugyte & Kokki, 2007 Level II). A combination of individually titrated intraoperative opioids and regularly administered perioperative mild analgesics (NSAID and/or paracetamol) is recommended for management of pain following tonsillectomy Level I).…”

Tonsillectomy Techniques and Pain: A Review of Randomized Controlled Trials and Call for Standardization

“…To name a few, investigators have compared acetaminophen, ketoprofen, meperidine, fentanyl, ketamine, tramadol and morphine in addition to atypical medications like magnesium and clonidine [64][65][66][67][68][69] . Some of the medications, such as meperidine, are more sedating than others, which may be confused with analgesia.…”