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High dose ibuprofen as a monotherapy on an around-the-clock basis fails to control pain in children undergoing tonsil surgery: a prospective observational cohort study

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Abstract

Purpose

The optimal pain management concept in children after tonsil surgery is controversial. Ibuprofen on an “around-the-clock” basis has been suggested to control postoperative pain sufficiently. Therefore, we established a standard scheme with weight-adapted recommended maximum ibuprofen dose. A reliable assessment of pain intensity can be performed with the Children’s and Infants’ Postoperative Pain Scale (CHIPPS) in children < 5 years, or with the Faces Pain Scale-Revised (FPS-R) in children aged ≥ 5 years. The Parents’ Postoperative Pain Measure (PPPM-D) may be a useful tool for both age groups. We hypothesized that not more than 30% of the children would need an opioid rescue medication during their in-hospital stay and analyzed the consistency of the PPPM-D with other pain scales.

Methods

We included 158 in-patients aged 2–12 years. Ibuprofen was orally administered every 8 h. Three times daily, pain scores were assessed by CHIPPS or FPS-R, respectively. The PPPM-D was used in all children. Exceeding the cut-off value in one of the tools was regarded as relevant pain.

Results

A rescue medication was needed in 82.1% of children after tonsillectomy and 51.3% of children after tonsillotomy (P < 0.001). The cut-off value for relevant pain was mostly exceeded in the PPPM-D, but its overall concordance to the reference scales was low.

Conclusion

High-dose ibuprofen “around-the-clock” is insufficient to control pain in children after tonsil surgery. Research is needed to find an optimal schema for management and assessment of postoperative pain.

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References

  1. Sutters KA, Isaacson G (2014) Posttonsillectomy pain in children. Am J Nurs 114:36–42

    Article  Google Scholar 

  2. Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R (2016) Clinical practice guideline: tonsillitis II. Surg Manag Eur Arch Otorhinolarngol 273:989–1009

    Article  Google Scholar 

  3. Statistisches Bundesamt [German Federal Statistical Office] (2017) DRG-Statistik. Wiesbaden

  4. Constant I, Ayari Khalfallah S, Brunaud A et al (2014) How to replace codeine after tonsillectomy in children under 12 years of age? Guidelines of the French Oto­Rhino­Laryngology Oto­Rhino­Laryngology—Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 131:233–238

    Article  CAS  Google Scholar 

  5. Ericsson E, Brattwall M, Lundeberg S (2015) Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years. Int J Pediatr Otorhinolaryngol 9:443–450

    Article  Google Scholar 

  6. Mitchell RB, Archer SM, Ishman SL et al (2019) Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 160:S1–S42

    Article  Google Scholar 

  7. Hobson A, Wiffen PJ, Conlon JA (2015) As required versus fixed schedule analgesic administration for postoperative pain in children. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858

    Article  PubMed  Google Scholar 

  8. Gude P, Rieckert C, Bissantz N et al (2018) Need of analgetics in children aged 2–12 years after tonsil surgery. Laryngorhinootologie 97:465–473

    Article  Google Scholar 

  9. Rodieux A, Piguet V, Desmeules J, Samer CF (2019) Safety issues of pharmacological acute pain treatment in children. Clin Pharmacol Ther 105:1130–1138

    Article  Google Scholar 

  10. Zahn PK, Sabatowski R, Schug SA, Stamer UM, Pogatzki-Zahn EM (2010) Paracetamol for perioperative analgesia. Old substance—new insights. Anästhesist 59:940–952

    Article  CAS  Google Scholar 

  11. Lönnqvist PA, Morton NS (2005) Postoperative analgesia in infants and children. Br J Anaesth 95:59–68

    Article  Google Scholar 

  12. Rakow H, Finke W, Mutze K, Reich A, Reinhold P, Strauß JM (2007) Handlungsempfehlung zur perioperativen Schmerztherapie bei Kindern. Anästh Intensivmed 48:99–103

    Google Scholar 

  13. Bringuier S, Picot MC, Dadure C et al (2009) A prospective comparision of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations. Pain 145:60–68

    Article  Google Scholar 

  14. Beyer JE, McGrath PJ, Berde CB (2009) Discordance between self-report and behavioral pain measures in children aged 3–7 years after surgery. J Pain Symptom Manag 5:350–356

    Article  Google Scholar 

  15. Twycross A, Voepel-Lewis T, Vincent C, Franck L, von Baeyer CL (2015) A debate on the proposition that self-report is the gold standard in assessment of pediatric pain intensity. Clin J Pain 31:707–712

    Article  Google Scholar 

  16. Stanford EA, Chambers C, Craig KD (2006) The role of developmental factors in predicting young children’s use of a self-report scale for pain. Pain 120:16–23

    Article  Google Scholar 

  17. Chambers CT, Finley GA, McGrath PJ, Walsh TM (2003) The parents’ postoperative pain measure: replication an extension to 2–6-year-old children. Pain 105:437–443

    Article  Google Scholar 

  18. Goebel S, Grimm S, Raab P, Ettl V, Faller H (2011) The German version of parents’ postoperative pain measure (PPPM-D). Validation on children 2–12 years old. Schmerz 25:534–543

    Article  CAS  Google Scholar 

  19. Wilton NC, Leigh J, Rosen DR, Pandit U (1988) Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology 69:972–975

    Article  CAS  Google Scholar 

  20. Leinbach RF, Markwell SJ, Colliver JA, Lin SY (2003) Hot vs cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 129:360–364

    Article  Google Scholar 

  21. Walther-Larsen S, Aagaard GB, Friis SM, Petersen T, Møller-Sonnergaard J, Rømsing J (2016) Structured intervention for management of pain following day surgery in children. Paediatr Anaesth 26:151–157

    Article  Google Scholar 

  22. Berghmans JM, Poley MJ, van der Ende J et al (2018) Association between children’s emotional/behavioral problems before adenotonsillectomy and postoperative pain scores at home. Paediatr Anaesth 28:803–812

    Article  Google Scholar 

  23. Vons KM, Bijker JB, Verwijs EW, Majoor HM, de Graaff JC (2014) Postoperative pain during the first week after adenoiectomy and guillotine adenotonsillectomy in children. Paediatr Anaesth 24:476–482

    Article  Google Scholar 

  24. Xin Y, Li X, Du J, Cheng J, Yi C, Mao H (2019) Efficacy of telephone follow-up in children tonsillecomy with day surgery. Indian J Pediatr 86:263–266

    Article  Google Scholar 

  25. McNab S (2016) Intravenous maintenance fluid therapy in children. J Paediatr Child Health 52:137–140

    Article  Google Scholar 

  26. Morinière S, Roux A, Bakhos D et al (2013) Radiofrequency tonsillotomy versus bipolar scissors tonsillectomy for the treatment of OSAS in children: a prospective study. Eur Ann Otorhinolaryngol Head Neck Dis 130:67–72

    Article  Google Scholar 

  27. Cantarella G, Viglione S, Forti S, Minetti A, Pignataro L (2012) Comparing postoerative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy. Auris Nasus Larynx 39:407–410

    Article  Google Scholar 

  28. Steward DW, Ragg PG, Sheppard S, Chalkiadis GA (2012) The severity and duration of postoperative pain and analgesia requirements in children after tonsillecomy, orchidopexy, or inguinal hernia repair. Paediatr Anaesth 22:136–143

    Article  Google Scholar 

  29. Büttner W, Finke W (2000) Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth 10:303–318

    Article  Google Scholar 

  30. de Azevedo CB, Carenzi LR, de Queiroz DL, Anselmo-Lima WT, Valera FC, Tamashiro E (2014) Clinical utility of PPPM and FPS-R to quantify post-tonsillecomy pain in children. Int J Pediatr Otorhinolaryngol 78:296–299

    Article  Google Scholar 

  31. Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN (2019) Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment properties. Pain 160:5–18

    Article  Google Scholar 

  32. Barbagallo M, Sacerdote P (2019) Ibuprofen in the treatment of children’s inflammatory pain: a clinical and pharmacological overview. Minerva Pediatr 71:82–99

    PubMed  Google Scholar 

  33. Roberts CA, Shah-Becker S, O'Connell Ferster A et al (2018) Randomized prospective evaluation of intraoperative intravenous acetaminophen in pediatric adenotonsillectomy. Otolaryngol Head Neck Surg 158:368–374

    Article  Google Scholar 

  34. Cohen N, Sommer DD (2016) Post-tonsillectomy pain control: consensus or controversy? Pain Manag 6:31–37

    Article  Google Scholar 

  35. Zhang LY, Zhong L, David M, Cervin A (2017) Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-dispordered breathing. Int J Pediatr Otorhinolaryngol 103:41–50

    Article  Google Scholar 

  36. Borgström A, Nerfeld P, Friberg D (2019) Postoperative pain and bleeding after adenotonsillectomy versus adenotonsillotomy in pediatric obstructive sleep apnea: an RCT. Eur Arch Otorhinolaryngol 276:3231–3238

    Article  Google Scholar 

  37. Hayhurst CJ, Durieux ME (2016) Differential opioid tolerance and opioid-induced hyperalgesia. Anesthesiology 124:483–488

    Article  Google Scholar 

  38. Kim SH, Lee MH, Seo H et al (2013) Intraoperative infusion of 0.6–0.9 µg kg(−1) min(−1) remifentanil induces acute tolerance in young children after laparoscopic uteroneocystostomy. Anesthesiology 118:337–343

    Article  CAS  Google Scholar 

  39. Davis PJ, Finkel JC, Orr RJ et al (2000) A randomized, double-blinded study of remifentanil versus fentanil for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Anesth Analg 90:863–871

    Article  CAS  Google Scholar 

  40. Roulleau P, Gall O, Desjeux L, Dagher C, Murat I (2003) Remifentanil infusion for cleft palate surgery in young infants. Paediatr Anaesth 13:701–707

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Dr. Nicolai Bissantz, Ph.D. at the Faculty of Mathematics, Ruhr-University Bochum, Bochum, Germany for his statistical support and Dr. Tobias Rothoeft, University Children’s Hospital, Ruhr-University Bochum, Bochum for the critical review of the manuscript.

Funding

Departmental funding only.

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Authors and Affiliations

  1. Department of Anaesthesiology, St. Josef and St. Elisabeth Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany

    Philipp Gude, Franziska Gustedt, Martin Bellgardt, Heike Vogelsang, Jennifer Herzog-Niescery & Thomas Peter Weber

  2. Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr-University Bochum, Bochum, Germany

    Stefan Dazert & Stefan Volkenstein

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  1. Philipp Gude
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  2. Franziska Gustedt
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  3. Martin Bellgardt
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  5. Jennifer Herzog-Niescery
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Correspondence to Philipp Gude.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Ethical Committee of the Ruhr-University Bochum, Bochum, Germany (registration number: 5108-14, 26 August 2015) and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual parents of the participating children included in the study. Moreover, children aged ≥ 7 years were age-appropriate informed about the study and asked to participate.

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Gude, P., Gustedt, F., Bellgardt, M. et al. High dose ibuprofen as a monotherapy on an around-the-clock basis fails to control pain in children undergoing tonsil surgery: a prospective observational cohort study. Eur Arch Otorhinolaryngol 277, 2115–2124 (2020). https://doi.org/10.1007/s00405-020-05929-5

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  • DOI: https://doi.org/10.1007/s00405-020-05929-5

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