title: Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children.
abstract: OBJECTIVE
  To determine the efficacy and safety of acetaminophen plus ibuprofen in treatment of post-tonsillectomy pain compared to acetaminophen plus opioids in children.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Tertiary-care children's hospital between September 2012 and March 2013.
  
  
  METHODS
  All children undergoing total tonsillectomy (n=1065). Analysis included descriptive analysis, chi-square testing, and logistic regression controlling for age, diagnosis, trainee involvement, concurrent surgical procedures, and Coblator use for differences of outcomes: (1) post-operative bleeding, (2) emergency department (ED) visits for pain, dehydration, or bleeding, and (3) nurse phone calls from families.
  
  
  RESULTS
  All patients received acetaminophen. Seventy-four percent received ibuprofen (n=783) and 26.5% did not receive ibuprofen (n=282). In the ibuprofen group, 32.2% received opioids (n=252). Over eight percent of children had post-operative hemorrhage of any amount reported (n=89). Forty-eight percent of these required operative intervention (n=43). Ibuprofen prescription did not impact post-operative bleeding; operative intervention for bleeding, ED visits, or nurse phone calls either on chi-squared or logistic regression testing. Increasing age was found to increase bleeding risk as well as the likelihood of visiting the ED or calling the clinic nurses. All patients with multiple bleeding episodes were in the ibuprofen group.
  
  
  CONCLUSIONS
  Prescription of ibuprofen did not increase the risk of bleeding and did not increase the likelihood of a post-operative ED visit or nurse phone call. Ibuprofen prescription may possibly increase the risk of multiple bleeding episodes, but further prospective studies are needed. Increased age increases the risk of bleeding, ED visits, and nurse phone calls.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Mattos
authors.affiliation: Division of Pediatric Otolaryngology, St. Luke's Children's Hospital, Boise, ID 83712, USA.
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Robison
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Greenberg
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. Electronic address: Robert.Yellon@chp.edu.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Yellon
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003681:Dehydration; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D019106:Postoperative Hemorrhage / Q000503:physiopathology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014068:Tonsillectomy
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D007052:Ibuprofen
keywords: Bleeding; Children; Non-steroidal anti-inflammatory; Pain; Sleep disordered breathing; Tonsillectomy