title: A randomised controlled trial of two analgesic techniques for paediatric tonsillectomy*.
abstract: Investigators from Bristol described a fentanyl- and diclofenac-based analgesic technique for tonsillectomy with low postoperative nausea and vomiting rates and low pain scores. This study compared the effectiveness of a modified Bristol technique with a codeine-based regimen with respect to PONV and analgesia. Sixty-five children, ASA 1-2, were randomly assigned to either the Bristol group (fentanyl 1-2 μg.kg(-1) and diclofenac 1-2 mg.kg(-1)) or codeine group (codeine 1.5 mg.kg(-1)). All children received paracetamol 15 mg.kg(-1) and dexamethasone 0.1 mg.kg(-1) . Postoperative nausea and vomiting and pain scores were recorded hourly, and fitness for discharge was assessed at 4 h. The overall incidence of postoperative nausea and vomiting was 21% with no difference between groups (Bristol group 8/30, codeine group 5/32, p = 0.29). Children in the Bristol group required analgesia earlier than those in the codeine group (p < 0.005), but maximum pain scores were not different (Bristol group median (IQR [range) 4.5 (3-5 [0-5]), codeine group 4.0 (2-5 [1-5]), p = 0.15). Twenty-three per cent of children were assessed as not fit for discharge at 4 h. The codeine-based regimen may have a small advantage over the Bristol regimen, but neither technique seems ideally suited for a day-case service without a longer period of observation. You can respond to this article at http://www.anaesthesiacorrespondence.com.
authors: Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors: E
authors: E
authors: Rawlinson
authors: A
authors: A
authors: Walker
authors: R
authors: R
authors: Skone
authors: A
authors: A
authors: Thillaivasan
authors: O
authors: O
authors: Bagshaw
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D017294:Ondansetron / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D015742:Propofol; D018401:Sample Size; D000077149:Sevoflurane; D014068:Tonsillectomy
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D008738:Methyl Ethers; D004008:Diclofenac; D000082:Acetaminophen; D000077149:Sevoflurane; D017294:Ondansetron; D003907:Dexamethasone; D005283:Fentanyl; D003061:Codeine; D015742:Propofol