Does ibuprofen, prednisolone, or amoxicillin reduce post-tonsillectomy pain in children? A prospective randomized controlled trial.

Abstract

OBJECTIVE\nTo evaluate whether the use of anti-inflammatory or antibiotic in the postoperative period modifies pain in children undergoing tonsillectomy.\n\n\nMETHODS\n225 children who underwent cold knife tonsillectomy\xa0±\xa0adenoidectomy were randomized 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.\n\n\nRESULTS\nAfter losses (24%), 170 individuals were submitted for analysis. 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\xa0>\xa00.05). The instances of analgesic intake were also similar in all the groups (p\xa0>\xa00.05), as was the return to solid food ingestion (p\xa0=\xa00.41). All groups presented a similar standard of clinical improvement at intervals of 2 days (p\xa0<\xa00.01). Independent of postoperative pain management, patients developed significant pain up to the day 4 following surgery.\n\n\nCONCLUSION\nThe addition of amoxicillin, ibuprofen, prednisolone, or amoxicillin and prednisolone does not modify postoperative pain in children undergoing cold-knife tonsillectomy. Special pain control should be performed on the first 4 days following tonsillectomy in children.