2015 HSC Section 1 Book of Articles

Otolaryngology–Head and Neck Surgery

the senior authors’ practice following the strong recommen- dation in the AAO-HNS guidelines against the routine use of perioperative antibiotics. 9 The use of antibiotics has not been definitively shown to affect postoperative morbidity, specifically pain and hemorrhage. 15 Multivariable analysis in the present study did not find antibiotic use to be a signif- icant predictor of ED return. The limitations of the present study include the retro- spective nature of the study. It is possible that patients may have visited an outside ED, and such events would not have been included in our chart review. This potential is mini- mized, however, because such information is routinely obtained during the first postoperative visit. Due to the severity of the warning from the FDA, it is unethical to design a prospective study using codeine without screening in some manner for rapid metabolizers. The value of the present study is that it bridges both time periods—prior to the FDA warning and after the FDA warning. Unfortunately, the retrospective nature of the study pre- cludes the use of direct or objective measures of pain con- trol. The rate of return to the ED due to pain and/or dehydration is a suitable surrogate metric and provides useful clinical information on the efficacy of a given post- operative analgesic regimen. Conclusion There is no difference in the primary and secondary out- come measures in posttonsillectomy patients based on the use of codeine and acetaminophen or ibuprofen and aceta- minophen. Codeine and ibuprofen perform similarly for postoperative analgesia in children after tonsillectomy with or without adenoidectomy with respect to ED utilization. Given the major concerns regarding codeine use in this pop- ulation, ibuprofen represents an acceptable and safe alterna- tive for pain control. Author Contributions Joshua R. Bedwell , conceived of and designed the study, analyzed the data, drafted the initial manuscript, and approved the final manuscript as submitted; Matthew Pierce , collected the data, per- formed initial data analysis, assisted in drafting the initial manu- script, and approved the final manuscript as submitted; Michelle Levy , collected the data, performed initial data analysis, and approved the final manuscript as submitted; Rahul K. Shah , designed the study, critically reviewed the manuscript, and approved the final manuscript as submitted. Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

young tonsillectomy patient. Otolaryngol Head Neck Surg . 1997;117:76-82. 2. Harley EH, Dattolo RA. Ibuprofen for tonsillectomy pain in children: efficacy and complications. Otolaryngol Head Neck Surg . 1998;119:492-496. 3. Pickering AE, Bridge HS, Nolan J, Stoddart PA. Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth . 2002;88:72-77. 4. Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillect- omy: a meta-analysis. Arch Otolaryngol Head Neck Surg . 2003;129:1086-1089. 5. Jeyakumar A, Brickman TM, Williamson ME, et al. Nonsteroidal anti-inflammatory drugs and postoperative bleed- ing following adenotonsillectomy in pediatric patients. Arch Otolaryngol Head Neck Surg . 2008;134:24-27. 6. Yaman H, Belada A, Yilmaz S. The effect of ibuprofen on postoperative hemorrhage following tonsillectomy in children. Eur Arch Otorhinolaryngol . 2011;268:615-617. 7. Kelly LE, Rieder M, van den Anker J, et al. More codeine fatalities after tonsillectomy in North American children. Pediatrics . 2012;129:e1343-e1347. 8. Kirchheiner J, Schmidt H, Tzvetkov M, et al. Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metaboli- zers due to CYP2D6 duplication. Pharmacogenomics J . 2007;7: 257-265. 9. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg . 2011;144(1)(suppl):S1-S30. 10. Blakley BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg . 2009;140:288-290. 11. Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospec- tive study. Laryngoscope . 2011;121:2553-2560. 12. Gallagher TQ, Hill C, Ojha S, et al. Perioperative dexametha- sone administration and risk of bleeding following tonsillect- omy in children: a randomized controlled trial. JAMA . 2012; 308:1221-1226. 13. Clark E, Plint AC, Correll R, Gaboury I, Passi B. A rando- mized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics . 2007;119:460-467. 14. Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR. Ibuprofen provides analgesia equivalent to acetaminophen- codeine in the treatment of acute pain in children with extre- mity injuries: a randomized clinical trial. Acad Emerg Med . 2009;16:711-716. 15. Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev . 2012;12:CD005607.

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