title: Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial.
abstract: BACKGROUND
  Pediatric sleep disordered breathing is often caused by hypertrophy of the tonsils and is commonly managed by tonsillectomy. There is controversy regarding which postsurgical analgesic agents are safe and efficacious.
  
  
  METHODS
  This prospective randomized clinical trial recruited children who had sleep disordered breathing who were scheduled for tonsillectomy +/- adenoid removal. Parents were provided with a pulse oximeter to measure oxygen saturation and apnea events the night before and the night after surgery. Children were randomized to receive acetaminophen with either 0.2-0.5 mg/kg oral morphine or 10 mg/kg of oral ibuprofen. The Objective Pain Scale and Faces Scale were used to assess effectiveness on postoperative day 1 and day 5. The primary endpoint was changes in respiratory parameters during sleep.
  
  
  RESULTS
  A total of 91 children aged 1 to 10 years were randomized. On the first postoperative night, with respect to oxygen desaturations, 86% of children did not show improvement in the morphine group, whereas 68% of ibuprofen patients did show improvement (14% vs 68%; P < .01). The number of desaturation events increased substantially in the morphine group, with an average increase of 11.17 ± 15.02 desaturation events per hour (P < .01). There were no differences seen in analgesic effectiveness, tonsillar bleeding, or adverse drug reactions.
  
  
  CONCLUSIONS
  Ibuprofen in combination with acetaminophen provides safe and effective analgesia in children undergoing tonsillectomy. Post-tonsillectomy morphine use should be limited, as it may be unsafe in certain children.
authors.affiliation: Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, and Ivey Chair in Molecular Toxicology, Western University, London, Ontario, Canada;
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Kelly
authors.affiliation: Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and.
authors.forename: Doron D
authors.initials: DD
authors.lastname: Sommer
authors.affiliation: Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and.
authors.forename: Jayant
authors.initials: J
authors.lastname: Ramakrishna
authors.affiliation: Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hoffbauer
authors.affiliation: Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Arbab-Tafti
authors.affiliation: Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and.
authors.forename: Diane
authors.initials: D
authors.lastname: Reid
authors.affiliation: Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Maclean
authors.affiliation: Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, and Ivey Chair in Molecular Toxicology, Western University, London, Ontario, Canada; Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada gkoren@sickkids.ca.
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D000082:Acetaminophen / Q000627:therapeutic use; D000233:Adenoidectomy; D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D007052:Ibuprofen / Q000009:adverse effects / Q000627:therapeutic use; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000097:blood / Q000188:drug therapy; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D014068:Tonsillectomy
chemical_list: D000082:Acetaminophen; D007052:Ibuprofen; D009020:Morphine; D010100:Oxygen
keywords: NSAID; adenotonsillectomy; children; ibuprofen; morphine; opiate; pain management; sleep apnea; sleep disordered breathing