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Research Letter
October 2017

Pediatric Posttonsillectomy Analgesia Before and After the Black Box Warning Against Codeine Use

Author Affiliations
  • 1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
  • 2Surgical Outcomes Research Center, University of Washington, Seattle
JAMA Otolaryngol Head Neck Surg. 2017;143(10):1052-1054. doi:10.1001/jamaoto.2017.1089

Tonsillectomy, a common ambulatory pediatric surgery, can result in substantial pain. It remains unclear what constitutes optimal analgesia following tonsillectomy.

Historically, codeine was commonly prescribed for acute pediatric pain, despite known variability in its metabolism.1 Case reports of respiratory depression and death following codeine administration for posttonsillectomy pain were published in 20092 and 2012,3 leading to a US Food and Drug Administration (FDA) “black box” warning against codeine use following tonsillectomy on August 15, 2012.4 This study investigates whether this regulatory change was followed by changes in prescribing patterns for analgesics following pediatric tonsillectomy.

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