Comparative study of acetaminophen-morphine versus rofecoxib-morphine for post-tonsillectomy pain control.

Abstract

Introduction: Although we routinely use morphine at our institution, moderate to severe pain often persists for several days after tonsillectomy. Nonsteroidal anti-inflammatory drugs could offer significant relief. Unfortunately, concerns about increased risk of bleeding limit their use. Selective inhibitors of cyclooxygenase type 2 (COX-2), such as rofecoxib, which do not affect bleeding time, could be an interesting option.

Objective: To evaluate the efficiency and safety of "rofecoxib-morphine" versus "acetaminophen-morphine" for post-tonsillectomy pain control.

Method: Eighty children (5-17 years old) took part in this prospective comparative study. Forty children were in the acetaminophen-morphine group (group A), and the remaining 40 children were in the rofecoxib-morphine group (group R). Pain scores, administered doses of medication, side effects, and the general health status of the child were collected by telephone calls made on the first, third, and seventh days after surgery.

Results: Pain scores for group A compared with group R are as follows: day 0 at home arrival, 4.6 to 2.5; day 0 average, 4.7 to 3.3; day 1, 3.6 to 2.6; day 3, 2.3 to 1.4; and day 7, 1.4 to 2.0. Moreover, children who received rofecoxib generally drank, ate, and returned to their regular activities more quickly than the children of group A. No side effects were reported with rofecoxib.

Conclusion: Rofecoxib (COX-2 inhibitor) significantly reduces pain scores after pediatric tonsillectomy. The combination of rofecoxib and morphine is safe and helps children return more quickly to their activities.