title: Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency department utilization.
abstract: OBJECTIVE
  To compare the performance of ibuprofen vs codeine for postoperative pain management after tonsillectomy as measured by need for emergency department (ED) treatment for pain and/or dehydration.
  
  
  METHODS
  Retrospective case series with chart review.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  Consecutive series of patients who underwent tonsillectomy with or without adenoidectomy at a tertiary children's hospital. Patients were categorized based on the type of postoperative pain management (acetaminophen with codeine vs acetaminophen and ibuprofen). The main outcome measure was the proportion of patients requiring ED visits or inpatient admissions for inadequate pain control or dehydration. Secondary measures included antibiotic use, postoperative hemorrhage, need for return to the operating room, vomiting, and oral diet tolerance.
  
  
  RESULTS
  Patients in the ibuprofen/acetaminophen group were younger than those in the codeine/acetaminophen group (6.2 vs 8.1 years, P < .05). Patients in the codeine/acetaminophen group were more likely to use antibiotics in the postoperative period (50.3% vs 5.9%, P < .05). The proportion of patients requiring ED visits or inpatient admission for dehydration was not significantly different between the groups (5.1% for codeine, 2.7% for ibuprofen, P = .12). Multivariable analysis controlling for age and antibiotic use showed no difference in ED visits or admission for dehydration (P = .09). There was no difference between the groups for any of the secondary measures.
  
  
  CONCLUSIONS
  Ibuprofen with acetaminophen represents a safe and acceptable analgesic alternative to codeine and acetaminophen in patients undergoing pediatric tonsillectomy.
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC, USA jbedwell@childrensnational.org.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Bedwell
authors.affiliation: Division of Otolaryngology, Georgetown University School of Medicine, Washington, DC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Pierce
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Levy
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods; D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; D000082:Acetaminophen; D003061:Codeine; D007052:Ibuprofen
keywords: adenoidectomy; codeine; ibuprofen; pain management; tonsillectomy