title: A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy.
abstract: BACKGROUND
  Postoperative pain, nausea and vomiting are frequent symptoms after tonsillectomy. There have been controversies concerning the advantages and drawbacks of different analgesics in this setting, especially non-steroidal anti-inflammatory drugs, because of potential side effects. We have evaluated the effectiveness and safety of a shift from prednisolone to ibuprofen for postoperative analgesia after tonsillectomy.
  
  
  METHODS
  Data from 1231 children scheduled for tonsillectomy over a period of 30 months were analysed. During the first period, children received a combination of paracetamol-prednisolone with codeine as a rescue therapy; in the second period, they received paracetamol and ibuprofen, with tramadol as a rescue therapy. All children received IV dexamethasone at 0.1mg/kg for antiemetic prophylaxis. The primary end-point was the incidence of severe pain defined as an Objective Pain Scale (OPS) score≥6 at the seventh postoperative day (POD7). Other end-points were postoperative nausea or emesis (PONV), sleep disturbance, oral intake and postoperative haemorrhage and reoperation.
  
  
  RESULTS
  Six hundred and seventy-two and 559 children were included in the prednisolone and ibuprofen groups respectively. OPS scores≥6 were observed in 3.1% of cases (95% confidence interval, 2.3-4.2%) on POD7 for the entire study population. Ibuprofen reduced the incidence of OPS scores≥6 on POD7 (relative risk 0.37, 95% CI: 0.18-0.78; P=0.009), OPS scores in the ambulatory unit (P<0.001) and POD1 (P<0.001), nalbuphine requirements (RR 0.42, 95% CI, 0.34-0.5, P<0.0001), and PONV (P=0.01) compared with prednisolone. Ibuprofen enhanced sleep quality on POD0 (P<0.0001) and POD7 (P=0.02), and oral intake on POD1 (P<0.0001). The incidence of bleeding requiring reoperation was comparable between the two groups (RR 0.8 [95% CI, 0.13-4.78], p=0.8). Predictive factors for an OPS score≥6 at POD7 were OPS score>4 on the morning and the evening of POD1 (OR 1.24, 95% CI 1.02-1.49, P=0.03 and OR 1.30, 95% CI 1.12-1.55, P=0.008, respectively) and prednisolone use (OR 2.37, 95% CI 1.06-5.31, P=0.04).
  
  
  CONCLUSIONS
  The administration of ibuprofen compared to prednisolone improves postoperative comfort in children undergoing ambulatory tonsillectomy without increasing the incidence of side effects.
authors.affiliation: Department of anaesthesiology and intensive care, centre hospitalier Privé-Sévigné, 3, rue du Chêne-Germain, 35510 Cesson-Sévigné, France. Electronic address: cavel35@gmail.com.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aveline
authors.affiliation: Department of anaesthesiology and intensive care, centre hospitalier Privé-Sévigné, 3, rue du Chêne-Germain, 35510 Cesson-Sévigné, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Le Hetet
authors.affiliation: Department of anaesthesiology and intensive care, centre hospitalier Privé-Sévigné, 3, rue du Chêne-Germain, 35510 Cesson-Sévigné, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Le Roux
authors.affiliation: Department of anaesthesiology and intensive care, Tenon university hospital, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75020 Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000556:Ambulatory Surgical Procedures; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D002675:Child, Preschool; D003061:Codeine / Q000627:therapeutic use; D005260:Female; D006306:Health Surveys; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D012890:Sleep / Q000187:drug effects; D014068:Tonsillectomy
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D000082:Acetaminophen; D011239:Prednisolone; D003061:Codeine; D007052:Ibuprofen
keywords: Complication; Non-steroidal anti-inflammatory; Pain; Tonsillectomy