A comparison of ibuprofen versus acetaminophen with codeine in the young tonsillectomy patient.

OBJECTIVE

To compare the use of ibuprofen with the use of acetaminophen with codeine for posttonsillectomy management.

BACKGROUND

We were not satisfied with our traditional pain-management practice for tonsillectomy patients. We hoped to find a new approach for improved patient comfort and avoid scheduled, abusable drugs such as codeine.

DESIGN

Intervention, prospective, randomized control trial. Follow-up was 1 month.

SETTING

University referral center; institutional pediatric practice, ambulatory.

PATIENTS

110 children undergoing tonsillectomy with or without other procedures. Consecutive patients were offered participation. Enrollees were randomly assigned to one of two classes and analyzed with the initial assignment. No patients withdrew for adverse effects, although 12 in group 2 used codeine and 5 of those used acetaminophen, whereas 2 in group 1 received ibuprofen.

INTERVENTIONS

Patients received either acetaminophen with codeine (group 1) or ibuprofen (group 2) for postoperative pain control.

MAIN OUTCOME MEASURES

The main outcomes, determined before initiation of the study, were assessment of (1) postoperative bleeding, (2) pain, (3) efficacy of relief of pain by drug, (4) nausea, (5) emesis, (6) readmission to hospital, (7) average temperature, and (8) highest temperature after surgery.

RESULTS

The only statistically significant difference is less nausea in patients receiving ibuprofen (p = 0.0049). Of note, no difference existed in postoperative bleeding, pain, or temperature control.

CONCLUSIONS

Ibuprofen is at least as effective as acetaminophen with codeine for postoperative pain control in children after tonsillectomy.