How to replace codeine after tonsillectomy in children under 12 years of age? Guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (SFORL)

Abstract

The authors present the guidelines of the French Oto-rhino-laryngology--Head and Neck Surgery Society (SFORL) regarding pain management in children and adults following tonsillectomy. A multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members' experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as professional agreement in decreasing order of level of evidence. At home, non-steroid anti-inflammatory drugs (NSAIDs) are recommended in association with paracetamol in elevated respiratory risk and especially obstructive sleep apnea syndrome; in elevated hemorrhagic risk (hemostasis disorder, surgical problems, etc.), tramadol is recommended. Two other treatment schedules (modified NSAIDs and corticosteroids) have not undergone dedicated study and should be assessed. Management of post-tonsillectomy pain in children is founded on individual risk/benefit analysis.

A European multicentre drug utilisation study of the impact of regulatory measures on prescribing of codeine for pain in children

“…32,33 Recognised possible therapeutic alternatives to codeine for treatment of pain in children include, eg, paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), coxibs, and opioid analgesics such as dihydrocodeine, tramadol, morphine, tapentadol, or oxycodone. [23][24][25][34][35][36][37][38][39][40][41][42][43][44] However, investigating whether a potential decrease in prescribing of codeine was associated with a shift in prescribing to other analgesics was considered outside the scope of the study. IMS® Germany includes data from a range of specialist physicians.…”

“…This led, in June 2013, to the PRAC recommending risk minimisation measures (RMM) including restrictions on its use and communications about the safety concerns by national authorities . Updated guidelines for analgesic use in children have since been published, in line with the regulatory communications …”

“…[14][15][16][17][18][19][20][21][22] Updated guidelines for analgesic use in children have since been published, in line with the regulatory communications. [23][24][25] The restrictions of use included that codeine should only be used in children 12 years or older for pain that cannot be relieved by other analgesics such as paracetamol or ibuprofen alone. Also, the lowest effective dose should be used for the shortest period of time in these children.…”

Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen

“…Die mittlere Dauer der Analgetikatherapie betrug dabei 7,8 Tage [11]. Trotz verschiedener Empfehlungen [12], [13] und zahlreicher Publikationen zum Thema "Schmerztherapie nach TE" wird in der wissenschaftlichen Literatur weiterhin von mittelstarken und starken Schmerzen nach TE berichtet [11], [14], [15].…”

Optimale Schmerztherapie nach Tonsillektomie: ein ungelöstes Problem

“…Bei Erwachsenen und bei anderen Corticosteroiden kann ein er höhtes Nachblutungsrisiko letztendlich auch nicht bewiesen werden, wenn auch einzelne Studien davon berichten[44]. Obwohl häufig eingesetzt, führt die alleinige Gabe von Paracetamol nicht zu einer ausreichenden Schmerzre duktion[47][48][49]. Paracetamol kann daher in Deutschland mit Metamizol, einem Cox2Hemmer oder einem nichtsteroidalen Antiphlogistika kombiniert werden.…”