Routine medications not effective in postoperative pain in cold-knife tonsillectomy

Carolina B.de Azevedo and colleagues from the Ribeirao Preto Medical School, University of São Paulo (FMRP-USP), Brazil carried out the present study to evaluate whether the use of anti-inflammatory or antibiotic in the postoperative period modifies pain in children undergoing tonsillectomy.

The authors randomized 225 children who underwent cold knife tonsillectomy ± adenoidectomy into five groups, receiving #1 metamizole/acetaminophen, #2 amoxicillin, #3 ibuprofen, #4 prednisolone, or #5 amoxicillin plus prednisolone.

All groups received oral analgesics (metamizole/acetaminophen) to use as needed. Pain was monitored during the 7 days following surgery using the Parents' Postoperative Pain Measurement (PPPM) and the Faces Pain Scale - Revised (FPS-R).

Pain was also indirectly evaluated by the dose of analgesics administered on each day and by the time needed to return to a solid diet.

The study revealed the following findings-

a. After losses (24%), 170 individuals were submitted for analysis.

b. Multiple comparisons demonstrated that the evolution of pain between the different groups, as matched day-per-day, was not significantly different by either PPPM or FPS-R (p > 0.05).

c. The instances of analgesic intake were also similar in all the groups (p > 0.05), as was the return to solid food ingestion (p = 0.41).

d. All groups presented a similar standard of clinical improvement at intervals of 2 days (p < 0.01). e. Independent of postoperative pain management, patients developed significant pain up to the day 4 following surgery.

Hence, the authors concluded that "The addition of amoxicillin, ibuprofen, prednisolone, or amoxicillin and prednisolone does not modify postoperative pain in children undergoing cold-knife tonsillectomy."

However, special pain control should be performed on the first 4 days following tonsillectomy in children, they further added.