Parents Happier with Alternative to Liquid Meds for Tonsillectomy

After getting their tonsils out and going home from the hospital, along with ice cream, young children must take pain medication until their throat heals. But parents often have a tough time getting them to take their liquid pain medication. A new alternative method of administering the medication rectally has been shown to be safe and effective, according to a new study by physician-scientists at Morgan Stanley Children's Hospital of NewYork-Presbyterian and Columbia University Medical Center. The findings were presented on January 21 at a meeting of the Eastern Section of the Triological Society in Toronto.

"Giving children liquid medication after throat surgery is difficult because of their refusal to take pain medication, postoperative nausea, vomiting, and difficulty swallowing. Our study found that parents had an easier time administering suppositories, and more parents would switch or consider switching from oral pain medication to suppositories if given the choice," says Dr. Joseph Haddad, Jr., the study's lead author. He is the Lawrence Savetsky Professor and Vice Chairman of Clinical Otolaryngology/Head and Neck Surgery at Columbia University College of Physicians and Surgeons and director of pediatric otolaryngology/head and neck surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian.

Without pain medication, a child may become dehydrated due to difficulty swallowing. In some cases this will necessitate a trip back to the hospital for IV fluid and pain management. A previous study found that up to 20 percent of children under 5 years of age experienced nausea postoperatively and as many as 14 percent of children became dehydrated.

The current study followed 75 children aged 1 to 5 who had a tonsillectomy or adenotonsillectomy (the removal of both tonsils and adenoids) and were given either rectal or oral postoperative pain medication consisting of codeine and acetaminophen. Postoperative pain was adequately controlled in those patients receiving suppositories when compared to those receiving oral pain medication. Adverse side effects were few and the total number of doses given per day were similar for both methods.

Additionally, rectal codeine is absorbed more rapidly than oral codeine, according to previous studies.

Children who objected to suppository administration were older than those objecting to oral pain medication, and were switched to oral pain medication. The findings suggest that suppositories may be more accepted and easier to administer in children 3 years of age or younger.

In the United States there are more than two million adenotonsillectomies and tonsillectomies performed on children each year, making them two of the most common operations. The surgeries are performed to relieve upper airway obstruction in children with recurrent tonsil infections.