Opioids and acute pain medicines — branching viva

I would stop the codeine immediately. Codeine is contraindicated in children under 12 years and for postoperative pain after tonsillectomy or adenoidectomy in children under 18 years. ^{[1] [2]} This child sits squarely in both contraindicated groups: he is four years old and he has just had a tonsillectomy. I would replace it with a safe modern regimen — scheduled paracetamol and ibuprofen, with oral morphine or oxycodone as rescue — and because he has obstructive sleep apnoea I would monitor him overnight with continuous oximetry, use the smallest effective opioid dose, and avoid any background infusion. ^{[6] [9]}