title: Tramadol versus codeine/acetaminophen after pediatric tonsillectomy: A prospective, double-blinded, randomized controlled trial.
abstract: OBJECTIVE
  Tonsillectomy is one of the most common pediatric surgical procedures performed in the United States. The postoperative period can be particularly painful, and there is currently no consensus on an optimal analgesic regimen. The objective of this study was to evaluate efficacy and safety of the single drug tramadol versus codeine/acetaminophen post-tonsillectomy.
  
  
  METHODS
  Prospective, double-blinded, randomized controlled trial.
  
  
  METHODS
  Large, Midwestern US pediatric hospital.
  
  
  METHODS
  Eighty-four children aged 4-15 years who underwent a tonsillectomy (with or without adenoidectomy) procedure were randomized and 74 were included in the analysis.
  
  
  METHODS
  Group 1 received liquid codeine/acetaminophen for 10 days post-tonsillectomy (5 days scheduled, followed by 5 days as-needed). Group 2 received liquid tramadol for 10 days post-tonsillectomy (5 days scheduled, followed by 5 days as-needed).
  
  
  METHODS
  Efficacy and side effects were evaluated using a 10-day take-home diary that was completed by parents.
  
  
  RESULTS
  Children in both study arms reported adequate post-tonsillectomy pain management without significant differences between groups in pain scores. Oversedation was significantly higher on the day of surgery in the codeine/acetaminophen group, and itching was experienced by significantly more children in the tramadol group during the postoperative period.
  
  
  CONCLUSIONS
  As part of multimodal analgesia, scheduled plus as-needed tramadol may be considered for children in the postoperative setting due to its analgesic properties, low potential for side effects, and good safety profile.
authors: Medical Director, Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Associate Professor of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
authors: Stefan J
authors: SJ
authors: Friedrichsdorf
authors: Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors: Andrea C
authors: AC
authors: Postier
authors: Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors: Laurie Pane
authors: LP
authors: Foster
authors: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Assistant Professor of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.
authors: Timothy A
authors: TA
authors: Lander
authors: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Assistant Professor of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.
authors: Robert J
authors: RJ
authors: Tibesar
authors: Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors: Yi
authors: Y
authors: Lu
authors: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Professor of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.
authors: James D
authors: JD
authors: Sidman
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D014147:Tramadol / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D014147:Tramadol; D003061:Codeine