Randomized comparison between the combination of acetaminophen and ibuprofen and
each constituent alone for analgesia following tonsillectomy in children.
Author(s): Merry AF(1), Edwards KE, Ahmad Z, Barber C, Mahadevan M, Frampton C.
Affiliation(s): Author information:
(1)Department of Anaesthesiology, Faculty of Medical and Health Sciences, University
of Auckland, Private Bag 92019, Auckland, 1142, New Zealand,
a.merry@auckland.ac.nz.
Publication date & source: 2013, Can J Anaesth. , 60(12):1180-9
PURPOSE: Combined acetaminophen and ibuprofen may be more effective than either
constituent alone for pain in adults. The combination was compared with the
individual constituents for analgesia following tonsillectomy in children.
METHODS: One hundred and fifty-two children (6-14 yr) undergoing tonsillectomy
were randomized to receive either combination acetaminophen (48
mg·kg(-1)·day(-1)) and ibuprofen (24 mg·kg(-1)·day(-1)) or the same doses of
acetaminophen alone or ibuprofen alone, every six hours for 48 hr. The primary
outcome measure was a time-corrected area under the curve (AUCt) calculated from
assessments on a 100-mm visual analogue scale (with Wong Baker FACES(®) as
anchors). At each assessment the children rated pain while at rest and on
swallowing at multiple time points over the study duration. Secondary outcome
measures were a global pain rating, requirement for rescue analgesia, sleep
disturbance, and frequency of adverse events.
RESULTS: The mean [standard error of the mean (SEM)] AUCt values at rest were;
combination 29.6 (1.9), acetaminophen 30.4 (2.0), ibuprofen 34 (1.9). The mean
(SEM) AUCt values on swallowing were; combination 39.1 (2.0), acetaminophen 39.9
(2.0), ibuprofen 43.7 (1.9). The mean (95% confidence interval) differences in
AUCt values between groups on swallowing were: combination vs acetaminophen -0.9
(-6.2 to 4.5); combination vs ibuprofen -4.6 (-9.9 to 0.67) and at rest were:
combination vs acetaminophen -0.81 (-6.11 to 4.48); combination vs ibuprofen
-4.37 (-9.62 to 0.88). Differences between groups were not clinically important
for the pain scores, similarly for the secondary outcomes.
CONCLUSION: The combination of ibuprofen and acetaminophen was not superior to
its individual components in the regimen studied in this pediatric population
undergoing tonsillectomy. The study was registered with the Australia New Zealand
Clinical Trial Registry (ACTRN12607000005459) on January 4, 2007.
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