Analgésie après amygdalectomie (podcast)

Tonsillectomy is an extremely painful surgical procedure. Postoperative pain is uncompletely controlled by paracetamol, used as a single drug. Tramadol efficacy and side effects (vomiting) depend on its metabolism by CYP2D6. Ketamine at dose less than 0.5 mg/kg is an antihyperalgesic agent that decreases opioid demand. Nefopam which is popular in France, cannot be used in children. NSAIDs are very effective and significantly reduce the incidence of PONV but a controversy still remains concerning the bleeding risk for their postoperative administration that could be solved to the advantage of selective COX-2 inhibitors. This controversy also exists for dexamethasone that produces a significant reduction in PONV and postoperative opioid demand. Codein is no more available but oxycodone which could be substituted is also dependent on CYP2D6 activity. Eventually postoperative analgesia is based on non-opioid agents (paracetamol plus NSAIDs); dexamethasone and setron reduce PONV while tramadol or opioid can be used as rescue analgesics.