Comparison of pre‐ and postoperative administration of ketoprofen for analgesia after tonsillectomy in children

Background:  Tonsillectomy is commonly performed in children, but unfortunately it is associated with intense postoperative pain. The use and optimal timing of nonsteroidal anti‐inflammatory drugs (e.g. ketoprofen) during tonsillectomy is controversial. Methods:  We evaluated the safety and efficacy of ketoprofen in 109 children, aged 3–16 years, during and after tonsillectomy in 1998–2000. Standardized anaesthesia was used. Forty‐seven children received ketoprofen 0.5 mg·kg –1 at induction (preketoprofen group) and 42 children after surgery (postketoprofen group), followed by continuous ketoprofen infusion of 3 mg·kg –1 over 24 h in both groups; 20 children received normal saline (placebo group). Oxycodone was used for rescue analgesia. Results:  Pre‐ and postketoprofen groups did not differ in experienced pain or in opioid consumption in the first 24 h after surgery; demonstrating that ketoprofen did not have a pre‐emptive effect. Patients in the placebo group received 30 more oxycodone doses than did patients in the ketoprofen groups, but the difference was not significant ( P =0.074). Two patients (5) in the postketoprofen group had postoperative bleeding at 4 h and 26 h, respectively. Both patients required electrocautery to stop bleeding. Neither the incidence nor the severity of adverse events differed between study groups. Conclusions:  This study demonstrates that ketoprofen did not have a preemptive effect and, at the dose used, did not perform statistically significantly better than placebo.