The efficacy and safety of Oramorph analgesia post paediatric tonsillectomy or adenotonsillectomy- a prospective service evaluation

Background
Codeine use in children post (adeno)tonsillectomy for obstructive sleep apnoea is contraindicated as its metabolism to morphine is unpredictable and associated with a significant risk of life-threatening respiratory depression.  Following pilot audit, children in Mid Essex Hospitals NHS Trust receive a schedule for over-the-counter analgesia with a backup of Oramorph.

Objectives
To assess the safety and efficacy of Oramorph post paediatric (adeno) tonsillectomy.

Methods
A prospective audit of paediatric patients undergoing (adeno)tonsillectomy.  Data collection includes: age, sex, indication for operation, surgeon, operation, operative technique, peri-op analgesia, post-op analgesia use, pain control on day 3/5*, 7,14 and a further phonecall on day 20 to note any GP contact, readmission rate, complications. *first phonecall would be on day 5 if day 3 was a weekend.

Results
Oramorph 0.2mg/kg 4-6 hourly PRN max TDS is routinely prescribed(n= 39, 100%).  Pain scores were not significantly different by operation, indication, surgeon, anaesthetist, operative technique, pre/peri op analgesia. 93% of patients were happy with pain relief given. There were no significant differences in pain scores between those taking Oramorph and those not taking Oramorph. Patients who took Oramorph had higher percentages of normal eating, however this did not reach significance p>0.05.

DISCUSSION & CONCLUSION
Parent satisfaction is high with a post-(adeno)tonsillectomy analgesia regime including Oramorph. Previous larger studies suggest that early use of Oramorph is correlated with subsequently lower pain scores and decreased likelihood of seeking medical advice re pain.  The lack of difference in our study may be a reflection of a smaller sample size.  Another critique is the lack of a comparison group, are pain scores and help-seeking behaviours better than prior to Oramorph prescribing? However it is reassuring that parents are satisfied with the regime, and there have not been Oramorph specific complications requiring additional input.  This service evaluation will continue so subgroup analyses can be done and to see if differences reach significance.  Consideration will be given to including a sister site which does not routinely prescribe Oramorph as a prospective comparator group.

The efficacy and safety of oramorph analgesia post paediatric tonsillectomy or adenotonsillectomy- a prospective service evaluation