Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial

Pediatrics. 2015 Feb;135(2):307-13. doi: 10.1542/peds.2014-1906.


Background: Pediatric sleep disordered breathing is often caused by hypertrophy of the tonsils and is commonly managed by tonsillectomy. There is controversy regarding which postsurgical analgesic agents are safe and efficacious.

Methods: This prospective randomized clinical trial recruited children who had sleep disordered breathing who were scheduled for tonsillectomy +/- adenoid removal. Parents were provided with a pulse oximeter to measure oxygen saturation and apnea events the night before and the night after surgery. Children were randomized to receive acetaminophen with either 0.2-0.5 mg/kg oral morphine or 10 mg/kg of oral ibuprofen. The Objective Pain Scale and Faces Scale were used to assess effectiveness on postoperative day 1 and day 5. The primary endpoint was changes in respiratory parameters during sleep.

Results: A total of 91 children aged 1 to 10 years were randomized. On the first postoperative night, with respect to oxygen desaturations, 86% of children did not show improvement in the morphine group, whereas 68% of ibuprofen patients did show improvement (14% vs 68%; P < .01). The number of desaturation events increased substantially in the morphine group, with an average increase of 11.17 ± 15.02 desaturation events per hour (P < .01). There were no differences seen in analgesic effectiveness, tonsillar bleeding, or adverse drug reactions.

Conclusions: Ibuprofen in combination with acetaminophen provides safe and effective analgesia in children undergoing tonsillectomy. Post-tonsillectomy morphine use should be limited, as it may be unsafe in certain children.

Trial registration: NCT01680939.

Keywords: NSAID; adenotonsillectomy; children; ibuprofen; morphine; opiate; pain management; sleep apnea; sleep disordered breathing.

Publication types

  • Consensus Development Conference
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / therapeutic use
  • Adenoidectomy
  • Administration, Oral
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Humans
  • Ibuprofen / adverse effects
  • Ibuprofen / therapeutic use*
  • Infant
  • Male
  • Morphine / adverse effects
  • Morphine / therapeutic use*
  • Oxygen / blood
  • Pain Measurement / drug effects
  • Pain, Postoperative / blood
  • Pain, Postoperative / drug therapy*
  • Prospective Studies
  • Sleep Apnea, Obstructive / surgery*
  • Tonsillectomy*


  • Acetaminophen
  • Morphine
  • Oxygen
  • Ibuprofen

Associated data