Children have a unique set of advantages and challenges when it comes to tonsillectomy . Their bodies are not the same as adults’. Resilience and ability to heal more quickly usually means a shorty recovery time, but special consideration should be given when giving pain medicine to children recovering from tonsillectomy and adenoidectomy surgery.
This article is written by Brian Stehula PharmD, RPh. Brian is a pediatric pharmacist working in a regional hospital. I’m very pleased to share with you his insights into the latest trends in pain medication for children, particularly those recovering from tonsillectomy surgery. -Greg Tooke My short bio
Post Tonsillectomy Pain Medication for Children
The recommendations for the best and safest pain control for pediatric patients after a tonsillectomy are changing. Concerns are now known when children receive a pain medication containing codeine after surgery. Although pain medication with codeine has worked well for some pediatric patients it also has been proven be quite dangerous for some children. Not all children’s bodies break down (metabolize) codeine at the same rate and therefore some children can get high amounts of pain medication in their body quickly. There have been some reports where the pain medication had built up so quickly that some children died from high amounts of medication in their system. These overdoses have happened even when normally recommended doses of codeine were given.
Instead of giving codeine we now know have safer choices that work just as well.. There is growing information that the after surgery, tonsil pain can be treated very well with over- the-counter (OTC) medications such as acetaminophen (TYLENOL) and ibuprofen (MOTRIN /ADVIL).
Doctors often have not used ibuprofen (MOTRIN/ADVIL brand names) because they believed it increased the chance of bleeding after tonsillectomy surgery. Children who are given ibuprofen starting the day after surgery very rarely have throat bleeding after tonsillectomy.
The current advice is to give acetaminophen (TYLENOL) in the recommended dose starting right after surgery and to repeat every four hours. Children who have no bleeding can also begin ibuprofen on the day after surgery. Surgeons are able to keep the stronger narcotic (examples include codeine, hydrocodone, and oxycodone) medications for those patients above 3 years of age who do not have good pain control with the acetaminophen (TYLENOL) and ibuprofen (MOTRIN/ADVIL) combination.
Some Tips for Child Tonsillectomy Pain Medication.
- Talk about options for pain control with your Pediatrician, Family Medicine, or Surgeon before surgery.
- Your Physician may include an anti-inflammatory steroid like dexamethasone for one to three daily doses after surgery.
- Throat pain is greater the first few days following surgery and may last up to two weeks.
- Talk to your child about their throat pain, if they are having pain the earlier you treat it the better the medication will work.
- Make sure that your child drinks plenty of fluids after surgery. Staying well hydrated is associated with less pain.
- Ibuprofen can generally be used safely for pain control starting the day after surgery.
- Pain medicine should be given in the dosage and timing as directed by your child’s Ear, Nose, and Throat Surgeon, Pediatrician, Ped’s Nurse or Pharmacist.
- For the first few days following surgery, medications should be given on a regular schedule to keep pain better controlled.
- Children may complain of pain in the morning more than other times of the day.
- Acetaminophen and Ibuprofen come in liquid form, chewable tablets, and regular tablets and capsules. Choose the form your child can most easily swallow.
- Rectal administration can be an option for young children refusing to take pain medication orally.
- Call your health care provider if you are unable to adequately control your child’s pain.
- Post-Tonsillectomy Pain Control
- •Acetaminophen (TYLENOL) on day of surgery give every four hour doses. Have your health care providers help you calculate the appropriate dose and when to give medicine.
- Ibuprofen (ADVIL/MOTRIN) 10 mg/kg/dose, maximum of three doses in 24 hours, beginning the day after surgery.
- When ibuprofen is started on day after surgery you can alternate it with acetaminophen.
- By giving acetaminophen every 8 hours and ibuprofen every eight hours you can alternate which medication is given every four hours.
Ages less than 3 years no narcotics.
Narcotics for pain include medications with hydrocodone, codeine, oxycodone and others. Some of these medications exist in forms that are combined with acetaminophen (Tylenol #3, Tylenol with Codeine liquid, Lortab, Vicodin, Percocet, and others)