Pain after tonsillectomy: effectiveness of current guidelines?

Accordingly to the most recent guidelines, pain management after tonsillectomy could combine acetaminophen (A) with ibuprofen (I) or tramadol (T). Therefore, in this research author revealed that A + I seems at least as capable as the combination A + T, without increasing readmission and additional surgery for bleeding.

Tonsillectomy is a common surgical procedure performed in children. Codeine usage in children was severely restricted in 2013. The French guidelines for treating tonsillectomy's postoperative pain at home have been reconsidered.
Our study aimed to measure the effectiveness and safety of two schedules, i.e. Acetaminophen + Ibuprofen (A + I) and Acetaminophen + Tramadol (A + T) in children who had tonsillectomy.

This is a 1 year prospective and observational single-center study considering children who underwent tonsillectomy. The option of the regimen, A + I group or A + T group, was done by the anesthesiologist in charge during the pre-anesthetic examination. After the hospital discharge, parents had to give systematically A + I or A + T, 4 times daily during 5 days and then,acetaminophen alone for the next 5 days. The primary endpoint was the home pain examined using the Parents' Postoperative Pain Measurement Short Form (PPPM-SF) scale. Secondary endpoints comprised of rate of further hospitalization and/or surgery because of tonsillectomy-related adverse events.

Three hundred and fourty two tonsillectomies were performed during the study period. Return rate of PPPM-SF scales was 58%. Total 200 patients were investigated. Median age was 4 years and was lower in group A + I (4 [3; 5]; 5 [4; 7]; p < 0.0001). PPPM-SF scores were higher than or equal to 3 in both the groups during the first 6 postoperative days. The mean decrease of PPPM-SF score with time was higher in group A + I as compared to group A + T (p = 0.007). Readmission rate was notably higher in A + T group  (A + I: 0; A + T: 7; p = 0.002) as the rate of reoperation for bleeding (A + I: 0; A + T: 3; p = 0.049).

After tonsillectomy, the home pain management should be improved. A + I appears to be least as effective as the combination A + T and, without increasing readmission and/or additional surgery for bleeding in the clinical practise.