ANALGESIA

FOR CHILDREN UNDERGOING TONSILLECTOMY (A CLINICAL TRIAL OF THREE ANALGESIC REGIMENS IN A PERIPHERAL HOSPITAL)

Abstract

Pain following tonsillectomy in children
is a significant problem that tends to be underestimated. Nonsteroidal anti-inflammatory drugs are effective in the
management of mild to moderate post-operative pain in children. They can decrease or even eliminate the need for
opioid analgesia, thus reducing the opioid-induced side effects. In this study, I used paracetamol alone and a
combination of paracetamol with either mefenamic acid or ibuprofen and examined the analgesia produced by all these
three regimens by using Wong and Baker facial pain scale. Patients and method: The study comprised of three groups
A, B, and C (50 patients in each group selected by non probability convenient method and randomly divided). Analgesia
was achieved in group A with paracetamol 20mg/kg, with paracetamol 20mg/kg plus mefenamic acid 10mg/kg in group
B and paracetamol 20mg/kg plus ibuprofen 5mg/kg in group C orally in syrup form. Post-operative pain was assessed
by Wong & Baker faces pain scale at recovery, 4, 8, 12 and 24 hours. Supplementary analgesia was given with oral
mefenamic acid (10 mg/kg) in-group B and ibuprofen (5mg/kg) in-group C; otherwise regular oral paracetamol (20
mg/kg-6 hourly) was given routinely in all three-study groups post-operatively. Results: Pain score was significantly
higher in paracetamol group as compared to mefenamic acid or ibuprofen groups (P<0.05), however there was no
significant difference in pain scores between mefenamic acid and ibuprofen groups. Conclusion: Although there is still
need for improving analgesia for tonsillectomy pain in children but I can acclaim that a combination of mefenamic acid
or ibuprofen with paracetamol is still the most useful, cheap and safe strategy in children, which avoids all opioids side
effects.