Impact of a revised postoperative care plan on pain and recovery trajectory following pediatric tonsillectomy

Abstract

Background A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate‐severe post‐tonsillectomy pain scores lasting a median (range) duration of 6 (0–23) days and postdischarge nausea and vomiting affecting 8% of children on day 1 following surgery. In this subsequent cohort, we evaluate the impact of changes to our discharge medication and parental education on post‐tonsillectomy pain and recovery profile. Methods In this follow‐on, prospective observational cohort study, all patients undergoing tonsillectomy at our institution during the study period were discharged with standardized analgesia. Parents received a revised education package and a medication diary which were not provided to the previous cohort. Pain scores, rates of nausea and vomiting, medication usage and unplanned representation rates were collected by telephone from parents. Results Sixty‐nine patients were recruited. Moderate‐severe pain lasted a median (range) of 5 (0–12) days. Twenty‐nine (42%) had pain scores ≥4/10 beyond postoperative day 7. By postoperative day 5, only 37 (53%) parents continued to administer regular analgesia. The median number of oxycodone doses used was 5 (0–22), and only 28 (41%) parents had disposed of leftover oxycodone within 1 month of surgery. Twenty‐four (35%) patients experienced nausea or vomiting postdischarge. The median (range) time for return to normal activities was 6 (0–14) days. Thirty‐two/sixty‐nine (46%) patients had unplanned medical representations. Most occurred between postoperative day 5 and 7. Pain contributed to 16 (35%) representations. Conclusions Despite extensive changes to our discharge protocols parents continued to report a prolonged period of pain, post operative nausea and vomiting, and behavioral changes. Further work is required to examine barriers to compliance with simple analgesia and education in appropriate methods of opioid disposal.

Remote after‐care using smartphones: A feasibility study of monitoring children’s pain with automated SMS messaging

“…17 The pain scores recorded follow a distribution that is similar to that seen in our previous audits of postoperative tonsillectomy pain (Figure 2), including a second pain peak roughly 5 days after surgery. 3,11 This is reassuring, as it shows that parents report pain scores consistently and in a similar range for the same surgery when communicating via SMS.…”

“…Tonsillectomy is a common pediatric surgical procedure which is well recognized as being associated with significant postoperative pain and an area of concern for pediatric anesthetists 10 . We have previously assessed parent‐proxy daily average pain following this procedure at our institution using telephone follow‐up 3,11 . We aimed to confirm support for SMS messaging follow‐up in our population, 8 and determine the feasibility of automated collection of variables with minimal researcher input compared to our previous studies.…”

“…10 We have previously assessed parent-proxy daily average pain following this procedure at our institution using telephone follow-up. 3,11 We aimed to confirm support for SMS messaging follow-up in our population, 8 and determine the feasibility of automated collection of variables with minimal researcher input compared to our previous studies.…”

Postoperative recovery in children: Turkish cross‐cultural adaptation

“…Approximately 25% of children undergoing tonsillectomy operations can still experience pain on the 10th day after surgery 2 . If children continue to experience complications after surgery, this may prolong their recovery process 3 …”

“…2 If children continue to experience complications after surgery, this may prolong their recovery process. 3 Delayed postoperative recovery creates a burden on both children and their families. It makes it difficult for the child to return to their routine and reduces their well-being even further.…”