Pain progression, intensity and outcomes following tonsillectomy

Abstract

The objective of this study was to assess outcomes of pediatric day surgery tonsillectomy. A total of 129 children, aged 5-16 years, and their parents were recruited from three urban hospitals which provided pediatric day surgery. Children reported pain on a visual analogue scale (VAS) in day surgery and then daily at home for 7 days. Parents reported outcomes of surgery, including fluid intake, nausea, vomiting and sleep disturbances. They also recorded analgesic administration. Three main results related to extent and duration of pain, quality of management of pain, and effect of pain on utilization of health services. Tonsillectomy caused considerable pain which lasted more than 7 days. Pain followed a trajectory of intense or moderately intense pain for the first 3 days followed by a gradual decline over the next 4 days. In general, post-tonsillectomy pain was poorly managed by health professionals and parents. An unexpected observation was that children who had a bupivacaine infiltration of the tonsil fossa during surgery had significantly more pain in the evening of surgery than children who did not have an infiltration. The increase in postoperative pain experienced by those who had the infiltration was attributed to quality of pain management. Children with persistent pain (those who did not follow the typical trajectory) were likely to be taken to a medical practitioner. One-third of the sample made unscheduled visits to practitioners with most occurring from Day 4 to Day 7 of the follow-up.

Pediatric Pain After Ambulatory Surgery: Where's the Medication?

“…In fact, it has been documented that up to 60% of parents seek consultation with their family doctors after tonsillectomy because of postoperative complications and concerns, including pain severity and duration. 9,32 Therefore, pain contributes to increased health care costs by increasing the need for unscheduled postoperative medical visits.…”

“…2 Indeed, researchers outside the United States suggested high levels of pain after tonsillectomy and adenoidectomy, as well as undertreatment of postoperative pain by parents. [3][4][5][6][7][8][9][10][11] The majority of those studies, however, had methodologic limitations such as small sample sizes, limited use of validated pain measures, and lack of a standardized approach to anesthesia and surgery.…”

“…Poor postoperative pain management among children has been linked to increased utilization of unscheduled medical visits, the majority of which are addressed by family physicians or pediatricians, rather than surgeons or physicians in the emergency department. 9 …”

Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children

“…Postoperative pain following tonsillectomy can be severe and last up to seven days with substantial associated distress for children and parents. 7 Acetaminophen and NSAIDs are commonly co-prescribed for postoperative analgesia, and combination therapy would simplify this regime. The results of a recent qualitative systematic review of the evidence for combining acetaminophen and an NSAID for postoperative pain in adults showed that the combination provided superior analgesia to either drug alone.…”

The Efficiacy of Anterior and Posterior Archs Suturation at Inferior Tonsillar Pole for Posttonsillectomy Pain Control

“…In posttonsillectomy term, especially adult patients usually suffer from severe pain during several days and the pain decreases step by step in following 4 days [3]. There are various analgesic medications for pain management, the spectrum of which varies from acetaminophen to narcotic analgesics.…”