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)

Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Sep;131(4):233-8. doi: 10.1016/j.anorl.2014.06.001. Epub 2014 Aug 6.


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.

Keywords: Analgesia; Anti-inflammatories; Codeine; Corticosteroids; Hemorrhage; Obstructive sleep apnea; Pain; Respiratory depression; Tonsillectomy; Vomiting.

Publication types

  • Practice Guideline

MeSH terms

  • Analgesics / therapeutic use*
  • Child
  • Child, Preschool
  • Codeine / therapeutic use*
  • Humans
  • Infant
  • Pain Management / standards*
  • Pain, Postoperative / drug therapy*
  • Risk Assessment
  • Tonsillectomy / adverse effects*


  • Analgesics
  • Codeine