PMID- 21607780
OWN - NLM
STAT- MEDLINE
DCOM- 20111123
LR  - 20211020
IS  - 1432-055X (Electronic)
IS  - 0003-2417 (Linking)
VI  - 60
IP  - 7
DP  - 2011 Jul
TI  - [Tonsillotomy and adenotonsillectomy in childhood. Study on postoperative pain 
      therapy].
PG  - 625-32
LID - 10.1007/s00101-011-1855-6 [doi]
AB  - BACKGROUND: The primary aim of this study was to determine whether the 
      combination of i.v. ketoprofen and i.v. paracetamol provides superior 
      postoperative analgesia in children undergoing adenoidectomy or tonsillotomy 
      compared to either drug alone. The secondary goal was to assess the time until 
      rescue analgesia was needed, propofol requirements and the incidence of vomiting 
      and time of discharge from the postanaesthesia recovery unit (PARU). METHODS: 
      This double-blinded study included 120 children (aged 3-13 years) scheduled for 
      elective tonsillectomy, adenoidectomy or adenotonsillectomy. The children were 
      randomly assigned to one of 3 groups of 40 children each, using the sealed 
      envelope method. The children received i.v. ketoprofen 2 mg/kgBW (group 1) or 
      paracetamol 15 mg/kgBW (group 2) or the combination of these 2 drugs (group 3) 
      after induction of anaesthesia. Standardized general anaesthesia consisted of 
      sevoflurane and fentanyl at a dose of 2-3 mug/kgBW. Pain was assessed using a 
      5-point scoring system based on the Smiley scale. The Smiley scale shows various 
      faces from a laughing face which corresponds to the state of no pain to a very 
      unhappy face which corresponds to the situation of worst pain (1: no pain, 2: 
      mild pain, 3: moderate pain, 4: severe pain, 5: worst pain). Pain was assessed at 
      30 min, 1 h, 2 h, 3 h and 4 h after arriving in the PACU. If the pain score 
      exceeded 2 an i.v. dose of 0.1 mg/kgBW morphine was administered as rescue 
      analgesia. RESULTS: During the stay in the PACU the children in the combination 
      group required significantly less supplementary rescue analgesia than children in 
      the ketoprofen and paracetamol groups (17.5% versus 30.8% versus 45%, 
      respectively, chi(2) analysis <0.05). Pain scoring was highest after paracetamol, 
      however, this difference was only significant when compared to the group 
      receiving the combination of paracetamol and ketoprofen (U-test p<0.05). Rescue 
      analgesia was administered earliest in group 2 (paracetamol) reaching statistical 
      significance, however, only when compared to group 3 (logrank test p<0.05). 
      Propofol requirements and time to discharge from the PACU did not differ 
      significantly between the 3 groups (chi(2) analysis; U-test; p>0.05). The overall 
      incidence of vomiting was very low in this study with 6.4% (9/139). Significantly 
      more children in the paracetamol group compared to ketoprofen group and 
      combination group suffered from vomiting (17.5% versus 2.6% versus 2.5%; chi(2) 
      analysis; p<0.05). The time to discharge from PACU did not differ significantly 
      between the 3 groups (U-test: p>0.05). CONCLUSION: The combination of i.v. 
      paracetamol and i.v. ketoprofen provides superior postoperative analgesia 
      compared to the single use of paracetamol.
FAU - Platzer, M
AU  - Platzer M
AD  - Abteilung fur Anasthesiologie und Intensivmedizin, Klinikum 
      Klagenfurt/Worthersee, Klagenfurt, Austria. manuela.platzer@lkh-klu.at
FAU - Likar, R
AU  - Likar R
FAU - Stettner, H
AU  - Stettner H
FAU - Jost, R
AU  - Jost R
FAU - Wutti, C
AU  - Wutti C
FAU - Leipold, H
AU  - Leipold H
FAU - Breschan, C
AU  - Breschan C
LA  - ger
PT  - English Abstract
PT  - Journal Article
PT  - Randomized Controlled Trial
TT  - Tonsillotomien und Adenotomien im Kindesalter. Studie zu postoperativen 
      Schmerztherapie.
DEP - 20110515
PL  - Germany
TA  - Anaesthesist
JT  - Der Anaesthesist
JID - 0370525
RN  - 0 (Analgesics, Non-Narcotic)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Anesthetics, Intravenous)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 362O9ITL9D (Acetaminophen)
RN  - 76I7G6D29C (Morphine)
RN  - 90Y4QC304K (Ketoprofen)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Acetaminophen/administration & dosage/therapeutic use
MH  - *Adenoidectomy
MH  - Adolescent
MH  - Analgesics, Non-Narcotic/administration & dosage/therapeutic use
MH  - Analgesics, Opioid/therapeutic use
MH  - Anesthetics, Intravenous/adverse effects
MH  - Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/therapeutic use
MH  - Child
MH  - Dose-Response Relationship, Drug
MH  - Double-Blind Method
MH  - Female
MH  - Humans
MH  - Ketoprofen/administration & dosage/therapeutic use
MH  - Male
MH  - Morphine/therapeutic use
MH  - Pain Measurement
MH  - Pain, Postoperative/*drug therapy
MH  - Postoperative Nausea and Vomiting/therapy
MH  - Propofol/adverse effects
MH  - *Tonsillectomy
EDAT- 2011/05/25 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/05/25 06:00
PHST- 2010/11/01 00:00 [received]
PHST- 2011/01/08 00:00 [accepted]
PHST- 2011/01/02 00:00 [revised]
PHST- 2011/05/25 06:00 [entrez]
PHST- 2011/05/25 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - 10.1007/s00101-011-1855-6 [doi]
PST - ppublish
SO  - Anaesthesist. 2011 Jul;60(7):625-32. doi: 10.1007/s00101-011-1855-6. Epub 2011 
      May 15.