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Issue N# 1 - 2017
PAEDIATRICS
Comparative study of analgesic effect of magnesium sulphate versus paracetamol on immediate post tonsillectomy pain in children
Authors : Hamamsy M, Awad M, Hamed MA, Abdelsttar A, Jabri WR. (Cairo)
Ref. : Rev Laryngol Otol Rhinol. 2017;138,1:9-13.
Article published in english 
Downloadable PDF document english
Summary :
Background: Control of postoperative pain, especially after adenotonsillectomy, has a very important effect on recovery time, hospitalization duration, hemodynamic disorders, bleeding, nausea, vomiting and medical costs. Tonsillectomy with or without adenoidectomy is the most prevalent surgical procedure in children. This surgery is accompanied by complications like nausea, vomiting, bleeding and postoperative pain. Pain is one of the most prevalent complications of tonsillectomy, which especially in children, may result in longer period of recovery and later discharge. Magnesium sulphate is an important medication that suppresses central nervous system and can help increase depth of anesthesia. It also has calcium antagonist properties that increase flaccidity. Paracetamol is a non-opioid analgesic used to reduce mild to moderate musculoskeletal, osteoarticular, menstrual and post minorsurgery pain, and toothache. In many articles and studies, different medications like opioids, NSAIDS, steroids and acetaminophen have been reviewed for reducing this post tonsillectomy pain. This study compared the efficiency of the analgesic effect of magnesium sulphate and paracetamol on post tonsillectomy pain in children in addition to their effect on nausea, vomiting and bleeding. Methodology: A double blind study which comprised 60 patients divided in two groups; group M which included 30 patients who received magnesium sulphate 30 mg/kg over 15 minutes started with induction of anaesthesia followed by continuous infusion of 10mg/kg/hour for one hour regardless the operation time. Group P which included 30 patients who received paracetamol infusion 10 mg/kg started with induction and continued for one hour irrespective of the duration of the operation. At the end of the operation, every patient was transferred to post anaesthesia care unit and was assessed by the nurse staff who wee unaware of the given medication. Results: There was no statistically significant difference between the two study groups regarding the vital signs (heart rate, mean arterial blood pressure, oxygen saturation) during the operation and in the post anesthesia care unit (PACU). There was no statistically significant difference regarding nausea, vomiting, bleeding, and sedation scores in the PACU between the two study groups. There was no statistically significant difference between the two groups regarding the pain scoring performed in PACU using the FLACC score (face, legs, activity, cry, consolabilty score) except at admission at PACU where the pain score was significantly lower in the M group. There was statistically significant difference between the two groups regarding the need for analgesics while in PACU. Numbers of patients taking analgesics among the two groups were 8 patients in the P group, while in M group were 2 only (p value 0.038). Conclusion: Both magnesium sulphate and paracetamol have analgesic effect on post tonsillectomy pain in children with higher efficacy of magnesium noted as shown by the statistical significance between the two drugs regarding the need for rescue analgesic in post anesthesia care unit.
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