Randomized clinical trial of non-opioid pain medications after intracapsular adenotonsillectomy

Background

Our purpose was to determine if non-opioid pain control is safe and effective in the treatment of pain following intracapsular adenotonsillectomy (T&A).

Methods

A randomized, open-label, controlled trial of children ages 3–17 undergoing intracapsular T&A was conducted at a tertiary children's hospital April 2021–May 2023. Exclusions were concomitant procedures, Down syndrome, coagulopathy, craniofacial anomalies, and current opioid use. Participants were randomized to receive a prescription for oxycodone (opioid group) or not (non-opioid group). All patients received ibuprofen/acetaminophen. The primary outcome, average Wong-Baker FACES pain scores on post-operative days 0–14, was compared between groups using t-tests. The secondary outcome, emergency department (ED)/urgent care visits, was compared using logistic regression.

Results

Age (median 4, range 3–12) and gender (42/70, 60 % male) were similar in both groups. Pain diaries were returned by 21/36 (58 %) in the opioid group and 23/34 (68 %) of the non-opioid group. Average pain was not different between groups before (opioid: mean 3.2, 95 % CI 2.5–3.8; non-opioid: mean 3.3, 95 % CI 2.5–4.0) or after (opioid: mean: 1.1, 95 % CI 0.6–1.5; non-opioid mean: 1.0, 95 % CI 0.5–1.5) analgesics. Only 7/21 (33 %) of the opioid group took ≥1 dose of oxycodone; no patients in the non-opioid group requested an opioid prescription. There were no differences in peak pain scores, duration of analgesic use, ED/urgent care visits, or caregiver-reported symptoms or satisfaction between groups.

Conclusions

Pain scores were low compared with previous reports in children undergoing extracapsular T&A, suggesting non-opioid management is appropriate for pain control in this population.