title: A new analgesia regimen after (adeno) tonsillectomy in children: a pilot study.
abstract: OBJECTIVE
  The objective was to ascertain the efficacy of a new analgesic regimen introduced in children undergoing (adeno)tonsillectomy in view of the ban on codeine use in children <12 years by the European Medicines Agency (EMA) and UK Medicines and Healthcare Products Regulatory Agency (MHRA).
  
  
  METHODS
  Prospective pilot study at a paediatric tertiary referral centre.
  
  
  METHODS
  A total of 176 children undergoing (adeno) tonsillectomy over a 5-month period (Sept 2013-Jan 2014) were included in the study. Data were prospectively collected on analgesia used peri-operatively and patients were discharged on regular paracetamol and ibuprofen for 7 days and three doses of oral morphine sulphate solution to be used on days 3, 4 and 5. Pain scores were recorded on days 1-10 post-operatively using the Wong Baker Faces Pain Rating scale.
  
  
  RESULTS
  The pain scores were significantly better (P-value < 0.0001) in children who were compliant with morphine (n = 93) than those who were not (n = 32). We also found that children who were compliant with morphine were less likely to seek help out of hours (P-value < 0.001).
  
  
  CONCLUSIONS
  Oral morphine sulphate solution provides a reasonable alternative to codeine, albeit one should bear in mind that parental concerns and adverse effects of the drug were seen in a minority of patients (n = 11) and anaesthetists were reluctant to prescribe the drug in cases of severe OSA or associated central apnoeas (n = 7).
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, UK.
authors.forename: M I
authors.initials: MI
authors.lastname: Syed
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, UK.
authors.forename: T A
authors.initials: TA
authors.lastname: Magos
authors.affiliation: Primary Biostatistical Solutions, Victoria, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Singh
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Montague
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000233:Adenoidectomy / Q000009:adverse effects*; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D059408:Pain Management; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010865:Pilot Projects; D011446:Prospective Studies; D012606:Scotland; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D009020:Morphine; D007052:Ibuprofen