High dose ibuprofen as a monotherapy on an around-the-clock basis fails to control pain in children undergoing tonsil surgery: a prospective observational cohort study.

Abstract

The optimal pain management concept in children after tonsil surgery is controversial. Ibuprofen on an "around-the-clock" basis has been suggested to control postoperative pain sufficiently. Therefore, we established a standard scheme with weight-adapted recommended maximum ibuprofen dose. A reliable assessment of pain intensity can be performed with the Children's and Infants' Postoperative Pain Scale (CHIPPS) in children < 5years, or with the Faces Pain Scale-Revised (FPS-R) in children aged ≥ 5years. The Parents' Postoperative Pain Measure (PPPM-D) may be a useful tool for both age groups. We hypothesized that not more than 30% of the children would need an opioid rescue medication during their in-hospital stay and analyzed the consistency of the PPPM-D with other pain scales. We included 158 in-patients aged 2-12years. Ibuprofen was orally administered every 8h. Three times daily, pain scores were assessed by CHIPPS or FPS-R, respectively. The PPPM-D was used in all children. Exceeding the cut-off value in one of the tools was regarded as relevant pain. A rescue medication was needed in 82.1% of children after tonsillectomy and 51.3% of children after tonsillotomy (P < 0.001). The cut-off value for relevant pain was mostly exceeded in the PPPM-D, but its overall concordance to the reference scales was low. High-dose ibuprofen "around-the-clock" is insufficient to control pain in children after tonsil surgery. Research is needed to find an optimal schema for management and assessment of postoperative pain.