Outcomes of an Alternating Ibuprofen and Acetaminophen Regimen for Pain Relief after Tonsillectomy in Children

Objectives: To determine the outcomes of alternating doses of ibuprofen and acetaminophen in the treatment of post-tonsillectomy pain in children and to identify characteristics of children who had inadequate pain control. Methods: The medical records of children who received alternating doses of ibuprofen and acetaminophen for post-tonsillectomy pain between August 2012 and November 2013 at a tertiary care children's hospital were reviewed. Incidences of postoperative bleeding and unresolved pain were determined. Results: A total of 583 patients (304 males, 279 females, age range =1-18 years) had received alternating doses of ibuprofen and acetaminophen after tonsillectomy and adenoidectomy. Of the 583 patients, 56 (9.6%) reported inadequate pain control. Age, sex, obesity, presence of comorbid conditions, indications for surgery, and concurrent surgical procedures were not different between children who had adequate analgesia and children who had unresolved pain. Twenty-four patients (4.1%) had postoperative bleeding. Nine patients (1.5%) required surgical intervention for bleeding. Conclusions: Alternating doses of ibuprofen and acetaminophen provided an effective treatment for post-tonsillectomy pain in the majority of children and did not increase rate of bleeding. Means of improving response rate to alternating doses of ibuprofen and acetaminophen merit further investigation.