Abstract :
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesics but their use during tonsil-lectomy is controversial because of the risk of postoperative bleeding.Objective: The aim of this study was to compare the analgesic efficacy and safety of ibuprofen, with paracetamol in the treatment of post-tonsillectomy pain.Patients and Methods: We conducted a prospective, single- blind, randomized clinical study. The sample of our study comprise a total of 80 generally healthy patients, aged 12-52 years, undergoing tonsillectomy were randomly assigned to receive either Paracetamol 1000mg or ibuprofen 400mg orally one hour before surgery. Subsequent doses of the same study medication were administered at 6-hour intervals for the first 7 days and thereafter when needed. During the first 24 post¬operative hours in hospital oxycodone was used for rescue analgesia, and after discharge patients were allowed to use a paracetamol-codeine combination for breakthrough pain. Recovery was recorded-up to 3 weeks after surgery.Results: The need for rescue analgesia during the first 24 hours was similar in the two study groups; 0-7 doses (mean ±SD 3.3±1.7 doses) in the paracetamol group and 0-11 doses (3.312.4 doses) in the ibuprofen group. After discharge significant differences were found between the two study groups in favour of the paracetamol-treated patients. Cessation of significant pain while swallowing occurred after 3-19 (10.91 3.8) days in the paracetamol group versus 7-20 (12.913.3) days in the ibuprofen group (p=0.041), and return to normal daily activities occurred after 3-21 (10.314.9) days in the paracetamol group versus after 3-19 (12.714.2) days in the ibuprofen group (p=0.048). At 3 weeks, six of 33 patients in the paracetamol group versus 15 of 37 patients in the ibuprofen group had pain during swallowing (p=0.049). One patient (3%) in the paracetamol group and five patients (12%) (p=0.22) in the ibuprofen group needed electrocautery to stop postoperative bleeding.Conclusion: Paracetamol is a viable alternative to the NSAIDs, especially because of the low incidence of adverse effects, and should be the preferred choice in high-risk patients. Oral paracetamol was as effective as ibuprofen in pain man-agement after tonsillectomy, and it improved the recovery after discharge.
