Comparison of pre- and postoperative administration of ketoprofen for analgesia after tonsillectomy in children

Background: Tonsillectomy is commonly performed in children, but unfortunately it is associated with intense postoperative pain. The use and optimal timing of nonsteroidal anti-inflammatory drugs (e.g. ketoprofen) during tonsillectomy is controversial. Methods: We evaluated the safety and efficacy of ketoprofen in 109 children, aged 3-16 years, during and after tonsillectomy in 1998-2000. Standardized anaesthesia was used. Forty-seven children received ketoprofen 0.5 mg.kg(-1) at induction (preketoprofen group) and 42 children after surgery (postketoprofen group), followed by continuous ketoprofen infusion of 3 mg.kg(-1) over 24 h in both groups; 20 children received normal saline (placebo group). Oxycodone was used for rescue analgesia. Results: Pre- and postketoprofen groups did not differ in experienced pain or in opioid consumption in the first 24 h after surgery; demonstrating that ketoprofen did not have a pre-emptive effect. Patients in the placebo group received 30% more oxycodone doses than did patients in the ketoprofen groups, but the difference was not significant (P = 0.074). Two patients (5%) in the postketoprofen group had postoperative bleeding at 4 h and 26 h, respectively. Both patients required electrocautery to stop bleeding. Neither the incidence nor the severity of adverse events differed between study groups. Conclusions: This study demonstrates that ketoprofen did not have a preemptive effect and, at the dose used, did not perform statistically significantly better than placebo.