The Drug Safety Monitoring Board has rejected the use of painkillers, among them morphine, for treating post-operative pain in children who just underwent tonsillectomy – because it could lead to potentially life-threatening respiratory problems among others.
The regulatory came to this conclusion when a study was halted midway because it amply proved this point. Ibuprofen has been proffered as an alternative to using powerful painkillers like codeine and morphine to kill pain in children that had their tonsils removed.
“These results should prompt clinicians to re-evaluate their post-tonsillectomy pain treatment regimen. Due to the unpredictable respiratory side-effects of morphine, its use as a first-line treatment with current dosage ranges should be discontinued for outpatient tonsillectomy,” says study co-author Dr. Doron Sommer.
According to the American Academy of Otolaryngology – Head and Neck Surgery (AAOHNS), 80% of tonsillectomies are now carried out to treat obstructive sleep problems.
Although codeine was the standard course of treatment for treating post-operative pains, a 2009 and 2012 study indicated that codeine could potentially cause life-threatening respiratory conditions in children. And as a result of this, the FDA issued codeine its strongest warning – a “boxed warning”.
This new research was conducted by staff from Motherisk Program at The Hospital for Sick Children, McMaster University in Ontario, Canada, and McMaster Children’s Hospital.
Ninety-one children aged 1-10 being randomly assigned post-operative painkillers to take at home following outpatient tonsillectomy surgery. Painkillers were to be prescribed from September 2012 to January 2014. One group of participants was given standard doses of oral morphine (0.2-0.5 mg/kg) and acetaminophen (10-15 mg/kg) to take every 4 hours. The other group of participants was given standard doses of oral ibuprofen (10 mg/kg) and acetaminophen (10-15 mg/kg) to take every 6 hours and every 4 hours respectively.
Parents of the children were asked to measure their children’s oxygen saturation and pauses in breathing using a home pulse oximeter; and they were shown how to assess the children’s pain levels using the Objective Pain Scale and Faces Scale and recorded pain levels on the first and fifth days after surgery. Both groups had their pain effectively managed by their medication, but there was a marked difference in the frequency of oxygen desaturation incidents in which the blood’s oxygen concentration falls.
On the first night after the surgery, 68% of the children that was treated with ibuprofen showed improvement in oxygen desaturation levels, but the group that had morphine had 14% improvement and desaturation events over time – at about a rate of 11-15 events per hour.
“The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for post-operative pain. We already know that they should not get codeine either,” says study author Dr. Gideon Koren. However, he added that “The good news is that we now have evidence that indicates ibuprofen is safe for these kids, and is just as effective in controlling their pain, so there’s a good alternative available for clinicians to prescribe.”