Comparison of Acetaminophen with or without Codeine to Ibuprofen on the Postoperative Pain of Pediatric Tonsillectomy

Management of pain in children is often inadequate and numerous clinical practice guidelines and policy statements have been published on the subject of pediatric pain. Tonsillectomy is among the most frequent otorhinolaryngologic surgeries, especially in the pediatric age group and after tonsillectomy the patients usually suffer from mild to severe pain for three postoperative days which may limit activity level and intake, leading to dehydration and a prolonged hospital stay. In this study acetaminophen, acetaminophen codeine and ibuprofen have been compared in a single study. A randomized, prospective, double-blind study was conducted at the Tabriz pediatric hospital. Patients were selected randomly from the hospitalized patients undergoing tonsillectomy suffering from recurrent tonsillitis or adenotonsillar hypertrophy and assigned to one of three groups (acetaminophen (ACT)-acetaminophen codeine (ACT/C)-ibuprofen (IBU) according to a predetermined randomization code. All the operations were taken place under same conditions by the same surgeon. Objective pain score used for pain assessment and adverse drug reactions were collected on checklists and analyzed using SPSS software. Chi square test results revealed a significant difference between ACT ACT/C IBU groups. Neither acetaminophen nor Ibuprofen at the doses given was able to provide sufficient analgesia. The rate of bleeding in all groups did not show any significant difference according to Pearson-chi-square test (P=0.22). The incidence of anorexia in ACT, ACT/C and IBU groups was 15.7, 7.8 and 25.8 percent, respectively, which showed a significant difference by chi-square test (P=0.045). According to our study it can be concluded that acetaminophen codeine posses more analgesic effect than acetaminophen and ibuprofen in post tonsillectomy pain management in pediatric patients.