Pain Relief and Sputum Prostaglandins in Adults Treated with Pethidine, Tilidine and Indomethacin After Tonsillectomy: A Double‐Blind Study

1 Otolaryngological Hospital, University of Helsinki. Helsinki, and Department of Biomedical Sciences, University of Tampere, Tampere. Finland. The pain‐relieving effects of pethidine (1 mg/kg i.m.), tilidine (2.5 mg/kg i.m.) and indomethacin (100 mg rectally) were investigated in 87 voluntary adult patients after tonsillectomy in a double‐blind study. All the drugs relieved pain equally. The maximal emerr appeared 60–75 min after drugadministration, and lasted until the end of the 120‐min observation period. Bleeding from the operative site w'as the most common side effect. It appeared in 28, 24 and 3% of the patients treated with indomethacin, tilidine and pethidine, respectively. Two patients in the indomethacin group and one patient in the tilidine group needed a suture for stopping the bleeding, whereas the bleeding in the pethidine group stopped without any special treatment. Further side effects were headache, dizziness, nausea and vomiting. Their incidence ranged from 0 to 17% in various groups. On the evening of the operative day, the indomethacin patients received another dose of indomethacin, whereas the other patients received a plarebo suppository. On the following morning, the pain score was lowest and the speech least impaired in the indomethacin patients. After indomethacin, the axillary temperature remained below 37 o C, whereas it was slightly elevated in the other groups. In all groups the blood leucocyte count was significantly increased. The control values for the excretion of prostaglandin F., in sputum ranged from 2.9 to 3.9 ng/8 min. The values were increased by 233, 183 and 29% in pethidine, tilidine and indomethacin group, respectively. The control values for prostaglandin E ranged from 1.5 to I.9 ng/8 min. There was an increase of 205, 111, and 80% in the pethidine, tilidine and indomethacin group, respectively. The results suggest that. of the drugs studied, pethidine is most convenient for treatment of throat pain immediately after tonsillectomy in adults. During the later postoperative period, indornethacin may be used for alleviation of pain and inflammatory responses.