This applies to Sweden. There may be other recommendations in the other Nordic countries.
Pain-relieving medications have the best effect when they are taken regularly throughout the day. Basic pain relief after a tonsil operation for otherwise healthy children are anti-inflammatory medications (Cox-inhibitors/NSAID e.g. Ipren, Diclofenac, Voltaren), which are to be taken together with medications that contain Paracetamol (e.g. Panodil, Alvedon). These medications are sold over the counter, and do not need a prescription at the pharmacy. How long the child needs to take pain-relievers depends on what type of tonsil operation was carried out. Make sure you buy the general pain medication before the surgery so that you have it at home when you get back from the hospital. If your child may need to supplement the medication with a prescription medication, then you will be given this at the time of the operation.
Recommended doses of medications are calculated for otherwise healthy children who can drink sufficient amounts of fluid. It is important to both eat and drink in the days after the operation in order to have a sufficient nutritional intake. If you have major difficulties getting your child to drink, then contact your doctor. Read more under the tab Important.
If your child does not want to take the medicine, then try another form of the medication. Most of the recommended medications are available as tablets, liquids, suppositories, orally soluble tablets or fizzy tablets. The pharmacy can help you to get the correct dose if you swap medicinal forms. When you leave the hospital, you will receive clear information about pain relief from the ward. If you go home on the day of the surgery, then find out how much medication your child has already received after the operation so you know how much medication to give him/her for the rest of the first day.
How long your child needs to take pain-relieving medication depends on what type of tonsil operation has been carried out. When the whole tonsil is removed (tonsillectomy), pain-relieving medication is often needed over a longer period of about 8 days, sometimes longer. If only parts of the tonsil have been removed (tonsillotomy) pain-relieving medication is commonly needed for about 5 days. Read more under the tab In-depth.
Phasing-out of medication/Tapering off medication
It is IMPORTANT that all children receive the recommended dose of pain-relieving medication the first days. When you and your child feel that he/she begins experiencing less pain, it is recommended that you stop taking paracetamol first. Continue to regularly give COX inhibitors/NSAID. Then as the pain intensity decreases, go over to giving COX inhibitors/NSAID only as needed. Read more under the page Pain assessment.
Inflammation inhibiting medications
COX inhibitors (NSAID/Non-steroidal anti-inflammatory drugs) both provide fast pain relief and inhibit inflammation. The pain-relieving effect is achieved within approx. 30 minutes of taking a tablet or oral solution. The recommended medication is Ibuprofen (e.g. Ipren, Brufen) OR Diclofenac (e.g. Diclofenac, Voltaren). Note that ONLY ONE OF THE recommended anti-inflammatory drugs should be used. Ibuprofen is available prescription-free in the following forms: tablet, mixture/liquid and suppositories. Diclofenac is available prescription-free in tablet form.
COX inhibitors can be given to most children, even those that have asthma, but it is VERY IMPORTANT that the first dose has already been given and has been evaluated at the hospital. If your child has asthma you should consult the doctor as to whether the child should take this medicine. The medicine must not be used if the child is allergic to acetylsalicylic acid or other COX inhibitors/NSAIDs, or if the child has an unusually easy tendency to bleed. The risk for side-effects increases with increasing doses. For all bleeding in the throat contact a health care professional IMMEDIATELY. Read more under the tab Important.
mg/kg = milligram per kilo of body weight of the child
- Ibuprofen days 1-8 = 5-7 mg/kg, the dose should be administered 4 times per day, every seventh hour (not more often)
(If your child weighs 61 kg or more then the max. dose is 400 mg x 4/day)
- Diclofenac days 1-8 = 1-1.5 mg/kg, the dose shall be administered 3 times per day, every eighth hour (not more often)
(If your child weighs 33 kg or more then the max. dose is 50 mg x 3/day)
Paracetamol (e.g. Alvedon, Panodil) reduces pain and fever but has no inflammation-inhibiting effect. The pain-relieving effect of the tablet or oral solution (taken via the mouth) is achieved within half an hour to one hour. For suppositories, it takes between two and three hours until the full effect is achieved. On the day of the operation and for 2 days following the tonsil operation (days 1-3), a higher dose of paracetamol is recommended. On day 4, it is important that the dose of paracetamol is reduced.
It is very important to follow the dose recommendations. At too high a dose over a longer period of time there is the risk of severe liver damage.
mg/kg = milligram per kilo of body weight of the child
- Paracetamol days 1-3 (day 1 is the day of the operation) = 24 mg/kg, the dose shall be administered 4 times per day, every seventh hour (not more often)
(If your child weighs 40-59 kg, then the max. dose is 1000 mg x 4/day. If your child weighs over 60 kg, then the max. dose is 1250 mg x 4/day)
- Paracetamol days 4-8 = 18 mg/kg, the dose should be administered 4 times per day, every seventh hour (not more often)
(If your child weighs 50 kg or more, then the max. dose is 1000 mg x 4/day.)
IMPORTANT: Children that undergo a tonsil operation must never use paracetamol combined with CODEINE (e.g. Citodon, Panocod), because codeine increases the risk of respiratory problems.
Read more under the headings Treatment period and Tapering off the medication.