Acetaminophen, ibuprofen, and tramadol analgesic interactions after adenotonsillectomy.

An interesting paper exploring optimal dosing of multimodal analgesia, specifically the effectiveness of combined ibuprofen and paracetamol, with or without tramadol, post adenotonsillectomy. The study included 251 children between 2 and 12 years, weighing greater than 10kg. The children where given a loading dose approximately 30 minutes before the start of surgery and dosing was then continued every 4‐6 hours, in hospital and at home for up to 11 days. The study found the analgesic effect is additive, but reaches a ceiling of a 65% reduction of pain score. Higher doses do not increase the ceiling but do prolong the duration of the effect. The use of rescue tramadol (0.75 mg/kg) given 5 h after the 4th dose of paracetamol (12 mg/kg) and ibuprofen (3.6 mg/kg) can prolong the duration of analgesia below a score of 6/10 for a further 7 h, potentially contributing to better overnight pain relief.

Reviewed by: Dr Michael Heytman