British Journal of Anaesthesia, 2002, Vol. 88, No. 1 72-77
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children
Sir Humphry Davy Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK*Corresponding author
Background. The analgesics used for paediatric tonsillectomy may be associated with side-effects such as sedation, respiratory depression and vomiting (opioids) or increased bleeding [non-steroidal anti-inflammatory drugs (NSAIDs)]. In our institution, we employ a combination of paracetamol, NSAID and opioid, although there is no published evidence of analgesic benefit from adding NSAIDs to paracetamol in children.
Methods. This randomized, double-blinded clinical study examined the analgesic effectiveness of combining paracetamol (20 mg kg–1) with rofecoxib (0.625 mg kg–1), ibuprofen (5 mg kg–1) or placebo as premedication for (adeno)tonsillectomy (n=98) in children aged 3–15 yr. Intravenous fentanyl 1–2 µg kg–1 was given intraoperatively. Regular oral paracetamol (15 mg kg–1, 4 hourly) was given after operation and could be supplemented on request from the child with oral ibuprofen 5 mg kg–1 or oral codeine 1 mg kg–1. The primary outcome variable was need for early supplementary analgesia (within 2 h after surgery).
Results. The addition of ibuprofen to paracetamol reduced the need for early analgesia from 72% to 38% of children (difference 34%; 95% confidence interval 4–64%). The addition of rofecoxib to paracetamol did not significantly alter the need for early analgesia (68 vs 72%). Pain scores were higher in those children who required early analgesia. There were no differences between the groups in operative blood loss or complications, total 24-h analgesic consumption, pain scores at 4 and 8 h, vomiting or antiemetic use.
Conclusion. This study provides evidence to support the combination of ibuprofen (but not rofecoxib) with paracetamol for perioperative analgesia in children.
Br J Anaesth 2002; 88: 72–7
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. Sun, O. Sacan, P. F. White, J. Coleman, R. J. Rohrich, and J. M. Kenkel Perioperative Versus Postoperative Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures Anesth. Analg., March 1, 2008; 106(3): 950 - 958. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N S Morton Management of postoperative pain in children Arch. Dis. Child. Ed. Pract., February 1, 2007; 92(1): ep14 - ep19. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Munsterhjelm, T. T. Niemi, O. Ylikorkala, P. J. Neuvonen, and P. H. Rosenberg Influence on platelet aggregation of i.v. parecoxib and acetaminophen in healthy volunteers Br. J. Anaesth., August 1, 2006; 97(2): 226 - 231. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hiller, O. A. Meretoja, R. Korpela, S. Piiparinen, and T. Taivainen The analgesic efficacy of acetaminophen, ketoprofen, or their combination for pediatric surgical patients having soft tissue or orthopedic procedures. Anesth. Analg., May 1, 2006; 102(5): 1365 - 1371. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. White The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-A. Lonnqvist and N. S. Morton Postoperative analgesia in infants and children Br. J. Anaesth., July 1, 2005; 95(1): 59 - 68. [Full Text] [PDF]
|
|
|
|
|
|
P. F. White Changing Role of COX-2 Inhibitors in the Perioperative Period: Is Parecoxib Really the Answer? Anesth. Analg., May 1, 2005; 100(5): 1306 - 1308. [Full Text] [PDF]
|
|
|
|
|
|
S. Turner and V. Ford Role of the selective cyclo-oxygenase-2 (COX-2) inhibitors in children Arch. Dis. Child. Ed. Pract., October 1, 2004; 89(2): ep46 - ep49. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Koomson, I. Morin, R. Brouillette, and K. A. Brown Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon: [Les enfants atteints d'un SAOS severe, operes pour amygdalectomie le matin, sont moins susceptibles de desaturation postoperatoire que les operes d'apres-midi] Can J Anesth, January 1, 2004; 51(1): 62 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Viitanen, N. Tuominen, H. Vaaraniemi, E. Nikanne, and P. Annila Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy{dagger} Br. J. Anaesth., September 1, 2003; 91(3): 363 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Walker and D. S. Wagner Treatment of Pain in Pediatric Patients Journal of Pharmacy Practice, August 1, 2003; 16(4): 261 - 275. [Abstract] [PDF]
|
|
|
|
|
|
W. Joshi, N. R. Connelly, S. S. Reuben, M. Wolckenhaar, and N. Thakkar An Evaluation of the Safety and Efficacy of Administering Rofecoxib for Postoperative Pain Management Anesth. Analg., July 1, 2003; 97(1): 35 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Recart, T. Issioui, P. F. White, K. Klein, M. F. Watcha, L. Stool, and M. Shah The Efficacy of Celecoxib Premedication on Postoperative Pain and Recovery Times After Ambulatory Surgery: A Dose-Ranging Study Anesth. Analg., June 1, 2003; 96(6): 1631 - 1635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Moiniche, J. Romsing, J. B. Dahl, and M. R. Tramer Nonsteroidal Antiinflammatory Drugs and the Risk of Operative Site Bleeding After Tonsillectomy: A Quantitative Systematic Review Anesth. Analg., January 1, 2003; 96(1): 68 - 77. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. B. Berde and N. F. Sethna Analgesics for the Treatment of Pain in Children N. Engl. J. Med., October 3, 2002; 347(14): 1094 - 1103. [Full Text] [PDF]
|
|