The Analgesic Efficacy of Preoperative Oral Ibuprofen and Acetaminophen in Children Undergoing Adenotonsillectomy: A Randomized Clinical Trial

Abstract

Background:Adenotonsillectomy is one of the most common surgical procedures in children. Several complications and morbidities are common after nasal surgeries and the most common is pain. Several techniques have been employed to reduce the severity of postoperative pain. One of the preoperative techniques is pre-emptive analgesia through preventive central hypersensitization. This technique is performed by applying analgesic methods before the onset of nociceptive stimuli, consequently decreasing postoperative analgesics requirements.Objectives:Preoperative oral drug administration for pain analgesia is performed in several methods. The aim of this study was to compare the analgesic effects of preoperatively administration of oral acetaminophen and ibuprofen.Patients and Methods:In a double-blinded, randomized placebo-controlled study, sixty 4-12 years old ASA I or II children scheduled for elective adenotonsillectomy, were assigned to receive either acetaminophen 15 mg/kg, ibuprofen 10 mg/kg or placebo 30 minutes before the operation. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), upon arrival to the post anesthetic care unit (PACU) and ward. Findings were analyzed by SPSS version 17 using variance analysis and Tukey’s test.Results:The average pain intensities were significantly lower in acetaminophen group based on the CHEOPS in both PACU and ward compared to ibuprofen or placebo groups; but there was no difference in pain intensity between the ibuprofen and placebo groups. Pain intensity in PACU in Acetaminophen group was 7.05 ± 0.64 vs. 8.38 ± 1.20 in placebo group and 8.14 ± 0.85 in ibuprofen group, pain intensity in ward in the acetaminophen group was 6.0.87 ± 0.85in the acetaminophen group, vs. 8.04 ± 1.02 in placebo group, and 7.78 ± 0.78 in ibuprofen group.Conclusions:This study showed that administration of oral acetaminophen 30 minutes preoperatively, resulted in significantly lower pain intensity in children undergoing adenotonsillectomy in PACU and ward, compared to ibuprofen and placebo.

Utilizarea Ibuprofenului În Febră, Durere Şi Inflamaţie La Copii

“…Rezultatele studiului au arătat o eficacitate analgezică similară, cu avantajul lipsei deprimării respiratorii induse de morfină, în cazul utilizării ibuprofenului. Alte cercetări recente au poziţionat utilizarea ibuprofenului ca opţiune validă de reducere a utilizării opioidelor în tratarea durerii după asemenea intervenţii (19,34).…”

Ibuprofen, a drug used in pain, inflammation and fever

“…The results of the study showed similar analgesic efficacy with the advantage of no morphine induced respiratory depresa, in case of ibuprofen use. Other recent researches positioned the ibuprofen use as a valid option for opioids usage reduction in treating pain after surgery (19,34).…”

Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management

“…Clinical data for paracetamol 15 mg/kg in children with pain are summarized in Table 2 . Paracetamol has been compared with ibuprofen [ 39 , 65 – 68 ], ketoprofen [ 69 ], naproxen [ 70 ], and codeine [ 66 ] in this setting. Studies of the use of paracetamol in pain show that paracetamol is generally as effective as ibuprofen, naproxen, and ketoprofen in reducing pain [ 39 , 65 , 69 , 70 ].…”