{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:04:15Z","timestamp":1788375855641,"version":"build-2803163510"},"reference-count":38,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>This prospective randomized clinical trial recruited children who had sleep disordered breathing who were scheduled for tonsillectomy +\/\u2212 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\u20130.5 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>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 &amp;lt; .01). The number of desaturation events increased substantially in the morphine group, with an average increase of 11.17 \u00b1 15.02 desaturation events per hour (P &amp;lt; .01). There were no differences seen in analgesic effectiveness, tonsillar bleeding, or adverse drug reactions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2014-1906","type":"journal-article","created":{"date-parts":[[2015,1,27]],"date-time":"2015-01-27T01:35:06Z","timestamp":1422322506000},"page":"307-313","source":"Crossref","is-referenced-by-count":154,"title":["Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial"],"prefix":"10.1542","volume":"135","author":[{"given":"Lauren E.","family":"Kelly","sequence":"first","affiliation":[{"name":"Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, and"},{"name":"Ivey Chair in Molecular Toxicology, Western University, London, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doron D.","family":"Sommer","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayant","family":"Ramakrishna","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Hoffbauer","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadaf","family":"Arbab-tafti","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Reid","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Maclean","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Koren","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, and"},{"name":"Ivey Chair in Molecular Toxicology, Western University, London, Ontario, Canada;"},{"name":"Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,2,1]]},"reference":[{"issue":"1","key":"2021120906363748900_B1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1177\/0194599810389949","article-title":"Clinical practice guideline: tonsillectomy in children","volume":"144","author":"Baugh","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1","key":"2021120906363748900_B2","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1213\/ane.0b013e3181a19e21","article-title":"Perioperative management of children with obstructive sleep apnea.","volume":"109","author":"Schwengel","year":"2009","journal-title":"Anesth Analg"},{"issue":"1","key":"2021120906363748900_B3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s12098-009-0266-z","article-title":"Pediatric obstructive sleep apnea.","volume":"77","author":"Chhangani","year":"2010","journal-title":"Indian J Pediatr"},{"issue":"11","key":"2021120906363748900_B4","first-page":"1","article-title":"Ambulatory surgery in the United States, 2006.","author":"Cullen","year":"2009","journal-title":"Natl Health Stat Rep"},{"key":"2021120906363748900_B5","unstructured":"US Food and Drug Administration. 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