Ketoprofen and tramadol for analgesia during early recovery after tonsillectomy in children

Summary Background: Pain following tonsillectomy is often intense. Nonsteroidal anti‐inflammatory drugs and opioids are effective, but both can cause adverse effects. Tramadol may be a viable alternative for post‐tonsillectomy pain. This study was designed to compare the analgesic effects of ketoprofen and tramadol during the early recovery period after tonsillectomy. Methods: Forty‐five ASA class I children (9–15 years) were randomized to receive either saline, ketoprofen (2 mg·kg −1 ) or tramadol (1 mg·kg −1 ) after induction of anesthesia. Upon completion of surgery, the study treatment was continued as a 6 h intravenous (i.v.) infusion of another dose of saline, ketoprofen (2 mg·kg −1 ) or tramadol (1 mg·kg −1 ). Postoperatively, each patient received rescue analgesia with patient‐controlled analgesia (PCA) device programmed to deliver 0.5 μ g·kg −1 bolus doses of fentanyl. Postoperative pain was assessed using Visual Analog Scale (VAS) during swallowing. Intraoperative blood loss was measured. Results: The total number of requests of PCA‐fentanyl was significantly less in ketoprofen group compared with tramadol and placebo groups ( P = 0.035 and P = 0.049, respectively, in pairwise comparisons) and the VAS scores for pain were significantly lower in ketoprofen group compared with tramadol ( P = 0.044) or placebo groups ( P = 0.018) during the first six postoperative hours. Measured intraoperative blood loss was greater in ketoprofen‐treated patients than in those receiving placebo ( P = 0.029). Conclusion: A dose of 4 mg·kg −1 of i.v. ketoprofen provided good pain relief with moderate supplemental PCA‐fentanyl requirements during the first six postoperative hours after tonsillectomy in children whereas the effects of 2 mg·kg −1 of i.v. tramadol did not differ from those of placebo.