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Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial

Published online by Cambridge University Press:  12 March 2013

A M A El-Fattah*
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Mansoura University, Egypt
E Ramzy
Affiliation:
Department of Anaesthesia and Intensive Care Unit, Faculty of Medicine, Mansoura University, Egypt
*
Address for correspondence: Dr Ahmed Musaad Abd El-Fattah, Otolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt Fax: +20 50 2267016 E-mail: ahmusaad@mans.edu.eg

Abstract

Introduction:

This double-blind, controlled, parallel-group study was designed to determine the efficacy of pre-emptive triple analgesia for paediatric post-tonsillectomy pain management.

Materials and methods:

One hundred and thirty-five children were randomised into two groups: pre-emptive triple analgesia (n = 55) and control (n = 80). Pain was assessed using a visual analogue scale (in hospital) and the Parent's Postoperative Pain Measure (at home), and scores recorded.

Results:

Visual analogue scale scores on awakening and for 6 hours post-surgery were significantly better in the study group than the control group (p < 0.05). The Parent's Postoperative Pain Measure scores of control group children were significantly higher within the first 3 post-operative days (p = 0.000), with a greater percentage of children experiencing significant pain and requiring more analgesia.

Conclusion:

The proposed multimodal, pre-emptive analgesia protocol for paediatric post-tonsillectomy pain results in less post-operative pain, both in hospital or at home.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013

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References

1Catlin, FI, Grimes, WJ. The effect of steroid therapy on recovery from tonsillectomy in children. Arch Otolaryngol Head Neck Surg 1991;117:649–52CrossRefGoogle Scholar
2Courtney, MJ, Cabraal, D. Tramadol, vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg 2001;127:385–8CrossRefGoogle ScholarPubMed
3Toma, AG, Blanshard, J, Eynon-Lewis, N, Bridger, MW. Post tonsillectomy pain: the first ten days. J Laryngol Otol 1995;109:963–4CrossRefGoogle ScholarPubMed
4Ozkose, Z, Akcabay, M, Kemaloglu, YK, Sezenler, S. Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children. Int J Pediatr Otorhinolaryngol 2000;53:207–14CrossRefGoogle ScholarPubMed
5Katz, J, Kavanagh, BP, Sandler, AN, Nierenberg, H, Boylan, JF, Friedlander, M et al. Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology 1992;77:439–46CrossRefGoogle ScholarPubMed
6Woolf, CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth 1989;36:139–46CrossRefGoogle Scholar
7Giannoni, C, White, S, Enneking, FK, Morey, T. Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Arch Otolaryngol Head Neck Surg 2001;127:1265–70CrossRefGoogle ScholarPubMed
8Kaygusuz, I, Susaman, N. The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2003;67:737–42CrossRefGoogle ScholarPubMed
9Sorensen, WT, Wagner, N, Aarup, AT, Bonding, P. Beneficial effect of low-dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy. A placebo-controlled clinical trial. Auris Nasus Larynx 2003;30:159–62CrossRefGoogle ScholarPubMed
10Nordbladh, I, Ohlander, B, Bjorkman, R. Analgesia in tonsillectomy: a double-blind study on pre and post-operative treatment with diclofenac. Clin Otolaryngol Allied Sci 1991;16:554–8CrossRefGoogle ScholarPubMed
11Anderson, B, Kanagasundarum, S, Woollard, G. Analgesic efficacy of paracetamol in children using tonsillectomy as a pain model. Anaesth Intensive Care 1996;24:669–73CrossRefGoogle ScholarPubMed
12Ali, SM, Shahrbano, S, Ulhag, TS. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with dextromethorphan. Laryngoscope 2008;118:1547–9CrossRefGoogle ScholarPubMed
13Wnek, W, Zajaczkowska, R, Wordliczek, J, Dobrogowski, J, Korbut, R. Influence of pre-operative ketoprofen administration (preemptive analgesia) on analgesic requirement and the level of prostaglandins in the early postoperative period. Polish J Pharmacol 2004;56:547–52Google ScholarPubMed
14Michaloliakou, C, Chung, F, Sharma, S. Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 1996;82:4451Google ScholarPubMed
15Eriksson, H, Tenhunen, A, Korttila, K. Balanced analgesia improves recovery and outcome after outpatient tubal ligation. Acta Anaesthesiol Scand 1996;40:151–5CrossRefGoogle ScholarPubMed
16Jin, F, Chung, F. Multimodal analgesia for postoperative pain control. J Clin Anesth 2001;13:524–39CrossRefGoogle ScholarPubMed
17Hultcrantz, E, Linder, A, Markström, A. Tonsillectomy or tonsillotomy? A randomized study comparing postoperative pain and long-term effects. Int J Ped Otorhinolaryngol 1999;51:171–6CrossRefGoogle ScholarPubMed
18Salonen, A, Kokki, H, Nuutinen, J. The effect of ketoprofen on recovery after tonsillectomy in children: a 3-week follow-up study. Int J Ped Otorhinolaryngol 2002;62:143–50CrossRefGoogle ScholarPubMed
19Lundeberg, S, Lönnqvist, PA. Update on systemic postoperative analgesia in children. Paediatr Anaesth 2004;14:394–7CrossRefGoogle ScholarPubMed
20Viitanen, H, Annila, P. Analgesic efficacy of tramadol 2 mg kg(-1) for paediatric day-case adenoidectomy. Br J Anaesth 2001;86:572–5CrossRefGoogle ScholarPubMed
21Engelhardt, T, Steel, E, Johnston, G, Veitch, DY. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine. Paediatr Anaesth 2003;13:249–52CrossRefGoogle ScholarPubMed
22Pickering, G, Loriot, MA, Libert, F, Eschalier, A, Beaune, P, Dubray, C. Analgesic effect of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clin Pharmacol Ther 2006;79:371–8CrossRefGoogle ScholarPubMed
23Graham, GG, Scott, KF. Mechanism of action of paracetamol. Am J Ther 2005;12:4655CrossRefGoogle ScholarPubMed
24Pappas, AL, Fluder, EM, Creech, S, Hotaling, A, Park, A. Postoperative analgesia in children undergoing myringotomy and placement equalization tubes in ambulatory surgery. Anesth Analg 2003;96:1621–4CrossRefGoogle ScholarPubMed
25Wurthwein, G, Koling, S, Reich, A, Hempel, G, Schulze-Westhoff, P, Pinheiro, PV et al. Pharmacokinetics of intravenous paracetamol in children and adolescents under major surgery. Eur J Clin Pharmacol 2005;60:883–8CrossRefGoogle ScholarPubMed
26Ang, C, Habre, W, Sims, C. Tropisetron reduces vomiting after tonsillectomy in children. Br J Anaesth 1998;80:761–3CrossRefGoogle ScholarPubMed
27Panarese, A, Clarke, RW, Yardley, MP. Early postoperative morbidity following tonsillectomy in children: implications for day surgery. J Laryngol Otol 1999;113:1089–91CrossRefGoogle ScholarPubMed
28Ewah, BN, Robb, PJ, Raw, M. Postoperative pain, nausea and vomiting following paediatric day-case tonsillectomy. Anaesthesia 2006;61:116–22CrossRefGoogle ScholarPubMed
29Pang, WW, Mok, MS, Huang, S, Hung, CP, Huang, MH. Intraoperative loading attenuates nausea and vomiting of tramadol patient-controlled analgesia. Can J Anaesth 2000;47:968–73CrossRefGoogle ScholarPubMed
30Uysal, HY, Takmaz, SA, Yaman, F, Baltaci, B, Başar, H. The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children. J Clin Anesth 2011;23:53–7CrossRefGoogle ScholarPubMed
31Swallow, J, Briggs, M, Semple, P. Pain at home: children's experience of tonsillectomy. J Child Health Care 2000;4:93–8CrossRefGoogle ScholarPubMed
32Unswarth, V, Franck, LS, Choonara, I. Parental assessment and management of children's postoperative pain: a randomized clinical trial. J Child Health Care 2007;11:186–94CrossRefGoogle Scholar
33Fortier, MA, MacLaren, JE, Martin, SR, Perret-Karimi, D, Kain, ZN. Pediatric pain after ambulatory surgery: where's the medication? Pediatrics 2009;124:588–95CrossRefGoogle ScholarPubMed