Fayyaz Hussain, Amran Hafiz, Mohammad Siddique.
Analgesia; for children undergoing tonsillectomy (a clinical trial of three analgesic regimens in a peripheral hospital).
Professional Med J Jan ;13(3):391-5.

Background and Objectives: 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.

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