Clin Otolaryngol. 2015 Oct 30.
Authors: Syed MI et al 1
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).
Prospective pilot study at a paediatric tertiary referral centre.
MATERIALS AND METHODS:
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 3 doses of oral morphine sulphate solution to be used on days 3, 4 and 5. Pain scores were recorded on days 1 to 10 post-operatively using the Wong Baker Faces Pain Rating scale.
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).
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).