Acetaminophen plus Ibuprofen for Treatment of Post-tonsillectomy Pain in Children

Abstract

Objectives:

Determine the efficacy and safety of acetaminophen plus ibuprofen in treatment of post-tonsillectomy pain compared to acetaminophen plus opioids in children.

Methods:

A retrospective medical record review was performed of children (n = 575) who underwent adenotonsillectomy at a tertiary care children’s hospital between September 2012 and January 2013. All patients received acetaminophen. 342 (59%) received ibuprofen, and 233 (41%) received opioids (oxycodone or hydrocodone) without ibuprofen. In the ibuprofen group, 109 (32%) received opioids. None received codeine. Descriptive analysis, two-tailed t-tests, and multivariate regression controlling for age and diagnosis analyzed differences of outcomes: 1) postoperative hemorrhage, 2) nurse phone calls from families, and 3) emergency department (ED) visits for pain, dehydration, or bleeding.

Results:

For the entire group, 7% had postoperative hemorrhage. 43% of these required operative intervention. There were 73 ED visits and 216 nurse calls. No significant difference was found in bleeding, ED visits, or nurse calls (P = 0.2, 0.8, and 0.3, respectively) between groups. No difference was found in operative intervention for hemorrhage (P = 0.9). No further difference was found when adjusting for age and/or diagnosis. After excluding the children who received ibuprofen plus opioids, there was still no significant difference in outcomes.

Conclusions:

There appears to be no difference in incidence of hemorrhage, operative intervention for bleeding, ED visits, or nurse calls between children receiving acetaminophen plus ibuprofen and those who received acetaminophen plus narcotics with/without ibuprofen. These data suggest that safety and pain control profiles are similar when using ibuprofen instead of opioids in post-adenotonsillectomy patients.