A Comparison of Postoperative Tramadol Versus Acetaminophen With Codeine in Children Undergoing Tonsillectomy
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ClinicalTrials.gov Identifier: NCT01267136 |
Recruitment Status :
Completed
First Posted : December 28, 2010
Results First Posted : April 17, 2014
Last Update Posted : April 17, 2014
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Tonsillectomy is the most common pediatric surgical procedure performed in the US. The postoperative period can be particularly painful. Codeine (usually in mixed formulation with acetaminophen) is the most commonly prescribed opioid in the US. However, evolving data questions its ability to provide optimal pain relief, while avoiding side effects, especially in the postoperative setting. Tramadol may be a better option for children in the postoperative setting due to its well-documented analgesic properties, low potential for side effects, and excellent safety profile. Seventy-two children scheduled to undergo tonsillectomy (with or without adenoidectomy) at Children's will be invited to participate in a randomized, prospective, double-blinded study to evaluate the efficacy and side effects of codeine with acetaminophen versus tramadol. Using a 10-day take-home diary, caregivers will be asked to record daily information about their child's postoperative pain and other core outcomes and domains as recommended in the recent consensus statement put forth by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) (McGrath et al., 2008). This study will offer new information regarding the efficacy and side effects associated with tramadol as compared with codeine/acetaminophen (the current practice standard) in a pediatric population.
Hypotheses
H1: Children who receive scheduled tramadol following tonsillectomy will report better pain control than children who receive scheduled codeine/acetaminophen.
H2: Children who receive scheduled tramadol following tonsillectomy will report fewer side effects than children who receive scheduled codeine/acetaminophen.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Tonsillitis Pain | Drug: Codeine with acetaminophen Drug: Tramadol suspension | Phase 4 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 84 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
Primary Purpose: | Treatment |
Official Title: | A Comparison of Postoperative Tramadol Versus Acetaminophen With Codeine in Children Undergoing Tonsillectomy |
Study Start Date : | January 2011 |
Actual Primary Completion Date : | May 2012 |
Actual Study Completion Date : | May 2012 |
Arm | Intervention/treatment |
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Experimental: Capital® with Codeine Suspension |
Drug: Codeine with acetaminophen
Liquid codeine/acetaminophen (Capital® 5mL= 120mg acetaminophen/12 mg codeine) 0.72 mg/kg [=0.3 mL/kg] (max. 36 mg) PO Q6h, plus 0.72 mg/kg (max. 36 mg) PO Q3h pro re nata (PRN) (max. of 3 PRN doses/day)
Other Names:
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Active Comparator: Tramadol suspension |
Drug: Tramadol suspension
Liquid tramadol 1.05 mg/kg [=0.3 mL/kg] (max. 52.5 mg) PO Q6h, plus 1.05 mg/kg (max. 52.5 mg) PO Q3h PRN (max. of 3 PRN doses/day).
Other Names:
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- Efficacy of Two Different Liquid Pain Medications: Tramadol vs. Codeine/Acetaminophen During the Post-tonsillectomy Recovery Period. [ Time Frame: Efficacy was assessed daily during the 10-day postoperative recovery period. ]Average number of post-operative days with pain score >4/10. Pain score assessments were administered once daily by parents using either the Numeric Rating Scale (NRS-11) (with anchors 0=no pain and 10=highest pain imaginable) for children ages 8-15 (von Baeyer et al., 2009) or the Faces Pain Scale-Revised (FPS-R) (with anchors 0=no pain and 10=highest pain imaginable) for children ages 4-10 (Hicks et al., 2001).
- Number of Participants Reporting Side Effects During the Post-tonsillectomy Recovery Period. [ Time Frame: Side effects will be observed and recorded daily by caregivers for a total of 10 days in the take-home diary. ]Parent-reported side effects entered in 10-day diary.

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Ages Eligible for Study: | 4 Years to 15 Years (Child) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Child must be scheduled to undergo tonsillectomy (with or without adenoidectomy).
- Child must be between the ages of 4 and 15 at the time of enrollment.
- Child and caregiver must be English-speaking.
- The same caregiver (e.g., mother) must agree to complete all study assessments with child to ensure consistency.
Exclusion Criteria:
- Child cannot self-assess pain due to conditions such as developmental delays, chromosomal abnormalities, and other syndromes.
- Child had significant adverse effects to codeine, tramadol, or acetaminophen in the past.
- Child has a known underlying seizure disorder (not febrile seizure).
- Child has known underlying renal or liver dysfunction (with creatinine, aspartate aminotransferase [AST]/amino alanine transferase [ALT], above normal value for age, respectively).
- Child or caregiver is not English-speaking.
- The same caregiver (e.g., mother) is unable to complete all follow-up assessments.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01267136
United States, Minnesota | |
Children's Hospitals and Clinics of Minnesota | |
Minneapolis, Minnesota, United States, 55404 |
Principal Investigator: | Stefan J Friedrichsdorf, M.D. | Children's Hospitals and Clinics of Minnesota |
Responsible Party: | Children's Hospitals and Clinics of Minnesota |
ClinicalTrials.gov Identifier: | NCT01267136 |
Other Study ID Numbers: |
1010-086 |
First Posted: | December 28, 2010 Key Record Dates |
Results First Posted: | April 17, 2014 |
Last Update Posted: | April 17, 2014 |
Last Verified: | March 2014 |
Tonsillectomy Pain Pediatric |
Opioids Tramadol Codeine |
Tonsillitis Pharyngitis Respiratory Tract Infections Infections Pharyngeal Diseases Stomatognathic Diseases Respiratory Tract Diseases Otorhinolaryngologic Diseases Acetaminophen Tramadol Codeine |
Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs Antipyretics Analgesics, Opioid Narcotics Central Nervous System Depressants Antitussive Agents Respiratory System Agents |