Does day case pediatric tonsillectomy increase postoperative pain compared to overnight stay pediatric tonsillectomy? A prospective comparative audit

Norrington, Amy; Flood, L M; Meek, T.; Tremlett, Michael

doi:10.1111/pan.12201

Cited by 15 publications

(8 citation statements)

References 10 publications

(10 reference statements)

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“…8 It is of note here that in a comparison of day-stay versus overnight inpatient stay, pain scores during the first 24 hours were only slightly increased for day-stay patients, and that the maximum pain scores at 24 hours and 7 days were similar. 9 This is contradicted by another audit, which found pain reports to be significantly higher at home than in the hospital. 10 Pain relief needs to also be provided for an extended period of time at home; the majority of children after tonsillectomy required at least one analgesic medication for 7 days after surgery.…”

Section: Quality Of Pain Relief After Ambulatory Surgerycontrasting

confidence: 49%

Postoperative pain management following ambulatory anesthesia: challenges and solutions

Schug¹,

Chandrasena²

2015

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Worldwide, there is an increasing trend toward performing more and more complex surgery in an ambulatory setting, partially driven by economic considerations. Provision of appropriate pain relief is still often inadequate in this setting; poor pain control and adverse effects of opioids provided for pain control are common reasons for readmission, with human and economic consequences. Therefore, improved analgesia after ambulatory surgery is an important goal; appropriate strategies include identification of at-risk patients, provision of multimodal analgesia, and early use of rescue strategies. Multimodal analgesia is based on the combined use of multiple medications or techniques for pain control, which have different mechanisms of action or act on different sites at the pain pathways. Thereby, such an approach improves analgesia, reduces opioid requirements, and reduces adverse effects of opioids. Important components of multimodal analgesia are nonopioids (acetaminophen and anti-inflammatory drugs), corticosteroids, and alpha-2-delta modulators (gabapentin, pregabalin), but most importantly the use of local and regional anesthesia techniques. Here, the use of adjuvants is one way to increase the duration of pain relief, but, increasingly, continuous peripheral nerve blocks via catheters are used in ambulatory patients, too. Finally, the planning of discharge medications needs a balancing act between the requirements for provision of good analgesia and the risk of opioids going out into the community.

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Section: Quality Of Pain Relief After Ambulatory Surgerycontrasting

confidence: 49%

Postoperative pain management following ambulatory anesthesia: challenges and solutions

Schug¹,

Chandrasena²

2015

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“…8 A single overnight admission has not been shown to improve posttonsillectomy pain control over a 7-day postoperative period compared with outpatient tonsillectomy. 33 Poor pain control is thought to contribute to poor oral intake and thus dehydration and bleeding following tonsillectomy. 17 Although prior studies have examined body mass index and obesity as a predictor of complication after tonsillectomy, weight has not been examined to date.…”

Section: Discussionmentioning

confidence: 99%

Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children

Lawlor

Riley

Carter

et al. 2018

JAMA Otolaryngol Head Neck Surg

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Healthy children younger than 3 years may be at an increased risk for complication following tonsillectomy. Those children may also be at increased risk for complications within the first 24 hours after surgery compared with children 3 years or older. Our data suggest that complications are independent of weight in these patients. In our cohort, those patients selected for overnight observation were associated with an increased number of adverse events following tonsillectomy, suggesting that clinician judgment is crucial in determining which patients are safe for outpatient tonsillectomy.

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“…Studies looking at children following T's ± A's have demonstrated high rates of significant pain in the first week post surgery, 52–86%, and pain lasting well into the second week . A study comparing day case vs overnight stay T's ± A's showed high rates of pain at home after the first postsurgical week in both groups of children suggesting length of the hospital stay is not a limiting factor .…”

Section: Discussionmentioning

confidence: 99%

“…There is limited evidence on the incidence, severity, and pattern of pain following discharge in children following surgery. Studies do suggest children are experiencing significant pain at home for an extended period which is associated with an increased incidence of behavioral disturbances and high rates of attendance to general practioners or Accident and Emergency departments .…”

Section: Introductionmentioning

confidence: 99%

The prevalence of pain at home and its consequences in children following two types of short stay surgery: a multicenter observational cohort study

Williams

Bell

Buys

et al. 2015

Pediatric Anesthesia

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The prevalence of pain at home, and its potential associated consequences, is high following short stay surgery in children in the UK. In both groups, high incidences were seen for longer periods than is commonly perceived. These findings were consistent between the centers involved suggesting that this is a significant national healthcare issue with potential short- and long-term consequences for the child, their family, and health services.

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Does day case pediatric tonsillectomy increase postoperative pain compared to overnight stay pediatric tonsillectomy? A prospective comparative audit

Abstract: Change in practice from overnight stay to day case surgery for pediatric tonsillectomy requires careful consideration of how to extend effective analgesia for this painful procedure into the home.

Cited by 15 publications

References 10 publications

Postoperative pain management following ambulatory anesthesia: challenges and solutions

Postoperative pain management following ambulatory anesthesia: challenges and solutions

Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children

The prevalence of pain at home and its consequences in children following two types of short stay surgery: a multicenter observational cohort study

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