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document
A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydrocodone for the management of postoperative pain in children after tonsillectomy . OBJECTIVES To determine the effectiveness of around-the-clock ( ATC ) analgesic administration , with or without nurse coaching , compared with standard care with as needed ( PRN ) dosing in children undergoing outpatient tonsillectomy . METHODS Children 6 to 15 years of age were randomized to receive acetaminophen and hydrocodone ( 167 mg/2.5 mg/5 mL ) for 3 days after surgery : Group A ( N=39 ) -every 4 hours PRN , with standard postoperative instructions ; Group B ( N=34 ) -every 4 hours ATC , with standard postoperative instructions , without nurse coaching ; and Group C ( N=40 ) -every 4 hours ATC , with standard postoperative instructions , with coaching . Parents completed a medication log , and recorded the presence and severity of opioid-related adverse effects and children 's reports of pain intensity using a 0 to 10 numeric rating scale . RESULTS No differences were found in analgesic administration or pain intensity scores between the 2 ATC groups . Therefore , they were combined for comparison with the PRN group . Children in the ATC group received more analgesic than those in the PRN group ( P < 0.0001 ) . Children in the PRN group had higher pain intensity scores compared to children in the ATC group , both at rest ( P=0.017 ) and with swallowing ( P=0.017 ) . Pain intensity scores for both groups were higher in the morning compared with the evening ( P < 0.0001 ) . With the exception of constipation , scheduled analgesic dosing did not increase the frequency or severity of opioid-related adverse effects . DISCUSSION Scheduled dosing of acetaminophen and hydrocodone is more effective than PRN dosing in reducing pain intensity in children after tonsillectomy . Nurse coaching does not impact parent 's adherence to ATC dosing .
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Intervention_Pharmacological
acetaminophen and hydrocodone
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Intervention_Pharmacological
acetaminophen and hydrocodone
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Intervention_Educational
without nurse coaching
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Intervention_Educational
with coaching
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Outcome_Other
efficacy
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Outcome_Other
effectiveness
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Outcome_Pain
Parents completed a
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Outcome_Other
medication log
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Outcome_Pain
, and recorded the
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Outcome_Adverse-effects
presence and severity of opioid-related adverse effects
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Outcome_Pain
and children 's reports of pain intensity using a 0 to 10 numeric rating scale .
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Outcome_Pain
pain intensity scores
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Outcome_Other
analgesic
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Outcome_Pain
pain intensity scores
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Outcome_Pain
Pain intensity scores
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Outcome_Adverse-effects
constipation
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Outcome_Adverse-effects
frequency or severity of opioid-related adverse effects
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Participant_Condition
postoperative pain
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Participant_Age
children
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Participant_Condition
tonsillectomy
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Participant_Age
children
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Participant_Age
6 to 15 years of age