A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen
and hydrocodone for the management of postoperative pain in children after
tonsillectomy.
Author(s): Sutters KA, Miaskowski C, Holdridge-Zeuner D, Waite S, Paul SM, Savedra MC,
Lanier B, Mahoney K.
Affiliation(s): Children's Hospital Central California, Madera, CA 93636-8761, USA.
ksutters@childrenscentralcal.org
Publication date & source: 2010, Clin J Pain. , 26(2):95-103
OBJECTIVES: To determine the effectiveness of around-the-clock (ATC) analgesic
administration, with or without nurse coaching, compared with standard care with
as needed (PRN) dosing in children undergoing outpatient tonsillectomy.
METHODS: Children 6 to 15 years of age were randomized to receive acetaminophen
and hydrocodone (167 mg/2.5 mg/5 mL) for 3 days after surgery: Group A
(N=39)-every 4 hours PRN, with standard postoperative instructions; Group B
(N=34)-every 4 hours ATC, with standard postoperative instructions, without nurse
coaching; and Group C (N=40)-every 4 hours ATC, with standard postoperative
instructions, with coaching. Parents completed a medication log, and recorded the
presence and severity of opioid-related adverse effects and children's reports of
pain intensity using a 0 to 10 numeric rating scale.
RESULTS: No differences were found in analgesic administration or pain intensity
scores between the 2 ATC groups. Therefore, they were combined for comparison
with the PRN group. Children in the ATC group received more analgesic than those
in the PRN group (P<0.0001). Children in the PRN group had higher pain intensity
scores compared to children in the ATC group, both at rest (P=0.017) and with
swallowing (P=0.017). Pain intensity scores for both groups were higher in the
morning compared with the evening (P<0.0001). With the exception of constipation,
scheduled analgesic dosing did not increase the frequency or severity of
opioid-related adverse effects.
DISCUSSION: Scheduled dosing of acetaminophen and hydrocodone is more effective
than PRN dosing in reducing pain intensity in children after tonsillectomy. Nurse
coaching does not impact parent's adherence to ATC dosing.
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