A new analgesia regimen after (adeno) tonsillectomy in children: a pilot study

Objective The objective was to ascertain the efficacy of a new analgesic regimen introduced in children undergoing (adeno)tonsillectomy in view of the ban on codeine use in children <12 years by the European Medicines Agency ( EMA ) and UK Medicines and Healthcare Products Regulatory Agency ( MHRA ). Design Prospective pilot study at a paediatric tertiary referral centre. Materials and methods A total of 176 children undergoing (adeno) tonsillectomy over a 5‐month period (Sept 2013‐Jan 2014) were included in the study. Data were prospectively collected on analgesia used peri‐operatively and patients were discharged on regular paracetamol and ibuprofen for 7 days and three doses of oral morphine sulphate solution to be used on days 3, 4 and 5. Pain scores were recorded on days 1–10 post‐operatively using the Wong Baker Faces Pain Rating scale. Results The pain scores were significantly better ( P ‐value < 0.0001) in children who were compliant with morphine ( n = 93) than those who were not ( n = 32). We also found that children who were compliant with morphine were less likely to seek help out of hours ( P ‐value < 0.001). Conclusions Oral morphine sulphate solution provides a reasonable alternative to codeine, albeit one should bear in mind that parental concerns and adverse effects of the drug were seen in a minority of patients ( n = 11) and anaesthetists were reluctant to prescribe the drug in cases of severe OSA or associated central apnoeas ( n = 7).