Routine medications not effective in postoperative pain in cold-knife tonsillectomy
Pain control should be optimized in the first 4 days following surgery, therefore, recent research published in the International Journal of Pediatric Otorhinolaryngology has found out that although special pain control should be performed, the addition of amoxicillin, ibuprofen, prednisolone, or amoxicillin and prednisolone does not modify postoperative pain in children undergoing 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.