Comparing The Efficacy of Ibuprofen alone with Ibuprofen and Paracetamol in Combination in Relieving Post Tonsillectomy Pain in Children: A Prospective Comparative Study
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Abstract
Background: Tonsillectomy is a frequent surgical intervention for recurrent tonsillitis in both adults and children, employing predominantly the cold steel method. Pain management post-surgery primarily involves NSAIDs and opioids, with varying degrees of effectiveness and side effects.
Objective: The study aimed to evaluate the pain relief efficacy of combining ibuprofen with paracetamol compared to the use of ibuprofen alone in children post-tonsillectomy.
Methods: Following ethical approval, 278 children with recurrent sore throat and quinsy were enrolled in an inpatient study at the Department of ENT, A unit of Hayatabad Medical Complex, Peshawar, from May 06 to August 30, 2023. This analytic cross-sectional study utilized a comparative prospective data collection approach and non-probability convenience sampling. Participants included 142 boys and 136 girls, aged 6 to 12 years.
Results: Of the total 278 children, 142 (51.1%) were male and 136 (48.9%) female. Ibuprofen alone was prescribed to 136 children, while 134 received a combination of ibuprofen and paracetamol. Among those treated with the combination therapy, 65 (23.4%) reported no pain (VAS scores 1-3). In contrast, those receiving ibuprofen alone reported moderate pain (VAS scores 4-7) as follows: 2.2% (N=6), 11.2% (N=31), 19.4% (N=54), and 9.4% (N=26); and severe pain (VAS scores 8-10) was reported by 6.5% (N=18) and 0.4% (N=1).
Conclusion: The combination of ibuprofen and paracetamol is significantly more effective in managing post-tonsillectomy pain in children compared to ibuprofen alone.
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References
Connon CR. The efficacy of a single dose antibiotic regimen in adults undergoing tonsillectomy. J Med Assoc. 2007;37(8):817-21.
Lee WC, Duigan MC, Walsh RM, Mc Rae-Moor JR. An audit of prophylactic antibiotic treatment following tonsillectomy in children. J Laryngol Otol. 2006;110(4):357-59.
Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;(11):1-25.
Grandis JR, Johnson JT, Vickers RM, Yu VL, Wagener MM, Wagner RL, Kachman KA. The efficacy of perioperative antibiotic therapy on recovery following tonsillectomy in adults: A randomized double-blind placebo-controlled trial. Otolaryngol Head Neck Surg. 2000;106(2):137-42.
Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: A review. Year.
Møiniche S, Rømsing J, Dahl JB, Trame`r MR. Nonsteroidal anti-inflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg. 2003;96(1):68–77.
Kelly LE, et al. More codeine fatalities after tonsillectomy in North American children. Pediatrics. 2012; Year: Volume(Issue):Page numbers.
Gardiner SJ, et al. Drug-metabolizing enzymes, and clinical practice. Pharmacol Rev. 2006;Year:Volume(Issue):Page numbers.
Restrictions on use of codeine for pain relief in children – CMDh endorses PRAC recommendation. EMA/385716. 2013.
Palme CE, et al. Evaluating the effects of oral prednisolone on recovery after tonsillectomy: a prospective, double-blind, randomized trial. Laryngoscope. 2000; Year:Volume(Issue):Page numbers.
Stelter K. Tonsillitis and sore throat in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc07.
Cohen LL, Lemanek K, Blount RL, et al. Evidence-based assessment of pediatric pain. J Pediatr Psychol. 2007;33(9):939-955.
von Baeyer CL. Children’s self-reports of pain intensity: scale selection, limitations and interpretation. Pain Res Manage. 2006;11(3):157-162.
Beltramini A, Milojevic K, Pateron D. Pain assessment in newborns, infants, and children. Pediatr Ann. 2017;46(10):e387-e395.
Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. Prospect guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(8):947–961.
Tolska HK, Hamunen K, Takala A, Kontinen VK. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. Br J Anaesth. 2019;123(5):e397–411.
Ericsson E, Brattwall M, Lundeberg S. Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years. Int J Pediatr Otorhinolaryngol. 2015;79(4):443–50.
Paganelli A, Khalfallah SA, Brunaud A, et al. Guidelines (short version) of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (SFORL) for the management of post-tonsillectomy pain in adults. Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(4):227–32.