The purpose of this study was to determine whether around-the-clock (i.e. ATC) dosing of acetaminophen with codeine, with or without nurse coaching, compared to standard care with as needed (i.e. PRN) dosing: reduced children's reports of pain intensity with and without swallowing; increased pain relief, and increased analgesic consumption. Eighty children, 6-15 years, undergoing tonsillectomy were randomized to one of three treatment groups to receive acetaminophen with codeine (120 mg/12 mg/5 ml) for 3 days after surgery: PRN group (N = 28)-every 4 h PRN, with standard postoperative instructions, without nurse coaching; ATC group (N = 26)-every 4 h ATC, with standard postoperative instructions, without nurse coaching; and ATC+coaching group (N = 26)-every 4 h ATC, with standard postoperative instructions and nurse coaching. In all three groups, significant decreases were found over time in pain intensity scores at rest (P < 0.001) and with swallowing (P < 0.001). However, mean pain scores at rest and with swallowing were >3/10 until the fourth evening after tonsillectomy. Children in both ATC dosing groups received significantly greater amounts of acetaminophen and codeine than children in the PRN group (P < 0.003). No significant differences were found in the amount of analgesic administered between the ATC dosing groups with and without nurse coaching. No significant differences were found in the amount of nausea and vomiting among the three groups. Scheduled dosing of acetaminophen with codeine did not provide adequate pain relief for children following tonsillectomy. Nurse coaching does not increase parent's adherence with an ATC dosing schedule.

Objectives To determine the effectiveness of around-the-clock (ATC) analgesic administration, with or without nurse coaching, compared to standard care with PRN dosing in children undergoing outpatient tonsillectomy. Methods Children 6 to 15 years were randomized to receive acetaminophen and hydrocodone (167mg/2.5mg/5ml) 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 to 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 following tonsillectomy. Nurse coaching does not impact parent's adherence to ATC dosing.

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