Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy

Oremule, Babatunde; Johnson, Mitchell A.; Sanderson, Lee M.; Lutz, Jan Markus; Dodd, Jodie M; Hans, Paul

doi:10.1016/j.ijporl.2015.09.040

Cited by 20 publications

(22 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results showed a stronger influence of daily pain intensity compared to average postoperative pain intensity on opioid administration. Prior studies have reported no differences in postoperative pain experiences between those treated only with OTC analgesics and those using additional opioids for breakthrough pain [25,26]. However, it is important to note that these studies relied on group averages, and thus do not capture individual daily variabilities in pain.…”

Section: Discussionmentioning

confidence: 99%

Child Pain Intensity and Parental Attitudes toward Complementary and Alternative Medicine Predict Post-Tonsillectomy Analgesic Use

et al. 2020

View full text Add to dashboard Cite

Parental attitudes regarding pain interventions and perceptions of their child’s pain intensity likely influence the decision to administer postoperative analgesics. Our study examined the impact of daily fluctuations in child pain intensity and parental attitudes regarding complementary and alternative medicine (CAM) on analgesic administration following pediatric tonsillectomy. Parents of children undergoing tonsillectomy (n = 33) completed a survey assessing CAM attitudes and a 7-day postoperative electronic daily diary to record their child’s daily pain intensity and analgesic medications (acetaminophen, ibuprofen, or oxycodone). Generalized linear mixed models with Poisson distributions evaluated the effects of within-person (child’s daily pain intensity) and between-person (average postoperative pain, parental CAM attitudes) components on the number of medication doses administered. Higher daily pain intensity was associated with more oxycodone doses administered on a given day, but not acetaminophen or ibuprofen. Positive parental CAM attitudes were associated with less oxycodone use, beyond the variations accounted for by the child’s daily pain intensity and average postoperative pain. Both parental CAM attitudes and their child’s daily pain intensity were independently associated with parental decisions to administer opioids following tonsillectomy. Understanding factors influencing individual variability in analgesic use could help optimize children’s postoperative pain management.

show abstract

Section: Discussionmentioning

confidence: 99%

Child Pain Intensity and Parental Attitudes toward Complementary and Alternative Medicine Predict Post-Tonsillectomy Analgesic Use

et al. 2020

View full text Add to dashboard Cite

show abstract

“…One study indicated that a majority of the children who were supplied with rescue analgesics after TE ± A used it. Most commonly, the first dose was taken on postoperative day 3 [ 42 ]. Increased knowledge about rescue analgesics is needed among health care professionals, children and their caregivers.…”

Section: Discussionmentioning

confidence: 99%

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Alm

Stalfors

Nerfeldt

et al. 2017

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to <18 years) during 2009–2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

show abstract

“…13 Oremule et al compared children getting acetaminophen together with ibuprofen (N = 24) with those who received morphine as needed in addition (N = 50). 14 They found no difference in mean worst pain score on day 4 but a higher score on day 7 for the morphine group. The number seeking advice post-op or being readmitted was not different, but more patients without morphine received an antibiotic when they sought outside help post-op (24% vs 5%).…”

Section: Comparisons With Other Studiesmentioning

confidence: 91%

Post-Tonsillectomy Outcomes in Children With and Without Narcotics Prescriptions

Carr

Schaefer

Schubart³

2019

Ear Nose Throat J

View full text Add to dashboard Cite

Objective: To examine differences in outcomes after tonsillectomy in children who received outpatient narcotics prescriptions compared to those who did not. Methods: The MarketScan database was analyzed for claims made for 14 days following tonsillectomy/adenotonsillectomy between 2008 and 2012 for privately insured children 1 to 17 years. Post-op bleeding, dehydration, emergency department (ED) visits, readmissions, and mean total costs for the 14 days after tonsillectomy were compared. Results: Of the 294 795 patients included, 60.9% received a narcotic prescription. Acetaminophen/hydrocodone bitartrate was received by 53.2% of the group receiving narcotic drugs, 42.5% received acetaminophen/codeine phosphate, 3.0% received acetaminophen/oxycodone hydrochloride, and 0.5% received oxycodone hydrochloride alone. Children who had been prescribed narcotics had significantly higher percentages of bleeding complications (2.7% vs 2.5%, P < .001), and ED visits (6.8% vs 6.6%, P < .001) within 14 days, but a lower percentage of readmissions (1.0% vs 1.5%, P < .001). No significant difference was observed between groups for dehydration. There were some age-related differences. The mean total health-care costs for 14 days post-op were the same in each group, except for the 4-to 6-year-olds, where the narcotic group had higher costs (US $7060 vs US $5840, P ¼ .006). Conclusion: In this large-scale study, we found small but statistically significant differences in outcomes related to use of narcotics. The only outcome that benefitted the narcotics group was a lower readmission rate.

show abstract

Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy

Cited by 20 publications

References 15 publications

Child Pain Intensity and Parental Attitudes toward Complementary and Alternative Medicine Predict Post-Tonsillectomy Analgesic Use

Child Pain Intensity and Parental Attitudes toward Complementary and Alternative Medicine Predict Post-Tonsillectomy Analgesic Use

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Post-Tonsillectomy Outcomes in Children With and Without Narcotics Prescriptions

Contact Info

Product

Resources

About