Comparing the Effect of Acetaminophen Suppository before and after Tonsillectomy on Pain Severity in Children
AbstractBackground: Pediatric tonsillectomy is associated with major complications such as severe postoperative pain. Hence, this study aimed to compare the effect of acetaminophen suppository administered before and after surgery on the pain severity of tonsillectomy.Methods: The present double-blind clinical trial was performed on 100 children undergoing tonsillectomy, who were randomly divided into two groups of 50 receiving respectively rectal acetaminophen 40 mg/kg preoperatively (Group 1) and postoperatively (Group 2).Results: The first group consisted of 28 boys and 22 girls, and the second group had 26 boys and 24 girls. According to Chi-square test, there was no significant difference in terms of gender in the two groups (p=0.668). Comparison of pain scores with repeated measures ANOVA showed lower pain severity in the first group at all hours compared with the second group.Conclusion: The preoperative use of acetaminophen suppository significantly controls the pain after tonsillectomy.
Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011; 144(1 suppl):S1-30.
Mitchell RB, Kelly J. Outcomes and quality of life following adenotonsillectomy for sleep-disordered breathing in children. ORL J Otorhinolaryngol Relat Spec. 2007; 69(6):345-8.
Subramanyam R, Varughese A, Willging JP, Sadhasivam S. Future of pediatric tonsillectomy and perioperative outcomes. Int J Pediatr Otorhinolaryngol. 2013; 77(2):194-9.
Bean-Lijewski JD, Kruitbosch SH, Hutchinson L, Browne B. Post-tonsillectomy pain management in children: Can we do better? Otolaryngol Head Neck Surg. 2007; 137(4):545-51.
El-Fattah A, Ramzy E. Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial. J Laryngol Otol. 2013; 127(4):383-91.
Liu C, Ulualp SO. Outcomes of an alternating ibuprofen and acetaminophen regimen for pain relief after tonsillectomy in children. Ann Otol Rhinol Laryngol. 2015; 124(10):777-81.
Prows CA, Zhang X, Huth MM, Zhang K, Saldana SN, Daraiseh NM, et al. Codeine‐related adverse drug reactions in children following tonsillectomy: A prospective study. Laryngoscope. 2014; 124(5):1242-50.
Ciszkowski C, Madadi P, Phillips MS, Lauwers AE, Koren G. Codeine, ultrarapid-metabolism genotype, and postoperative death. N Engl J Med. 2009; 361(8):827-8.
Kelly LE, Rieder M, van den Anker J, Malkin B, Ross C, Neely MN, et al. More codeine fatalities after tonsillectomy in North American children. Pediatrics. 2012;129(5): e1343-7.
Kuehn BM. FDA: no codeine after tonsillectomy for children. JAMA. 2013; 309 (11): 1100.
Rusy LM, Houck CS, Sullivan LJ, Ohlms LA, Jones DT, McGill TJ, et al. A double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding. Anesth Analg. 1995; 80(2):226-9.
St. Charles CS, Matt BH, Hamilton MM, Katz BP. A comparison of ibuprofen versus acetaminophen with codeine in the young tonsillectomy patient. Otolaryngol Head Neck Surg. 1997; 117(1):76-82.
Bedwell JR, Pierce M, Levy M, Shah RK. Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency department utilization. Otolaryngol Head Neck Surg. 2014; 151(6):963-6.
Mattos JL, Robison JG, Greenberg J, Yellon RF. Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol. 2014; 78(10):1671-6.
Subramanyam R, Varughese A, Kurth CD, Eckman MH. Cost‐effectiveness of intravenous acetaminophen for pediatric tonsillectomy. Paediatr Anaesth. 2014; 24(5):467-75.
Jabbari moghaddam Y KL, Radfar R, Ragifar R. Comparisional Results of Paractamol and Diclofanac Suppository on Post Tonsillectomy Pain Control in Children . Medical Journal of Tabriz University Medical Sciences and Health Services. 2009; 31(1):31-4.
Haddadi S, Marzban S, Karami MS, Heidarzadeh A, Parvizi A, Nabi BN. Comparing the duration of the analgesic effects of intravenous and rectal acetaminophen following tonsillectomy in children. Anesth Pain Med. 2014; 4(1): e13175.
Dashti G, Amini S, Zanguee E. The prophylactic effect of rectal acetaminophen on postoperative pain and opioid requirements after adenotonsillectomy in children. Middle East J Anaesthesiol. 2009; 20(2):245-9.
Nazem M, Sajedi P, Goharian V, Shirvani M. Comparing the effects of preincisional infiltration of Bopivacaine with postoperative rectal Acetaminophen on reducing postoperative pain after pediatric surgery. arak medical university journal 2006; 9(3):99-105.
Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab-tafti S, Reid D, et al. Morphine or ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015; 135(2):135(2):307-13.
Neda SJ, Farzad Z, Hamidreza J, sede Bahman S, Hamidreza Z. Comparative efficacy of diclofenac suppository and acetaminophen suppository alone And simultaneous prescription in controlling pain after tonsillectomy surgery in children. Arak Medical University Journal. 2016; 19(112):46-55.