Pharmacologic management of post‐tonsillectomy pain in children

Abstract

Tonsillectomy is a very common procedure in children, often performed on an outpatient basis. Severe postoperative pain is common, and can be prolonged. Despite a large number of available analgesic medications, often employed in combination, achieving adequate pain control remains a persistent challenge. Research suggests a tendency among caregivers to undertreat pain, and a need for detailed care instructions and education to ensure adequate pain management. Furthermore, ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results. This review summarizes the current state of the literature and presents a management approach which attempts to maximize pain control while minimizing potential harm with combinations of medications and modification based on patient-specific factors.

Is honey an effective adjunct to conventional analgesic agents for children post-tonsillectomy?

“…As a surgical intervention, the most common side effects include bleeding, infection and pain. The latter may be pharmacologically managed with a combination of conventional analgesic agents such as paracetamol, NSAIDs such as benzydamine spray and ibuprofen, opioids and a single intraoperative dose of dexamethasone 6 7. However, there are several challenges to achieving and maintaining effective analgesia such as weighing risks versus efficacy in cases of opioid administration and disordered sleep breathing, patient-specific factors such as difficulty in taking oral medicine or child anxiety, as well as parental factors such as hesitation due to the perceived risk of side effects 8–11.…”

A service evaluation of the impact of parental information provision on analgesia administration at home posttonsillectomy

“…3 The postoperative pain relief typically includes regular paracetamol and nonsteroidal anti-inflammatory drugs, with opioids as rescue analgesia where appropriate. 4 This regular analgesia strategy can improve pain scores and reduce opioid requirement and side effects. 5 Upon discharge, parents are responsible for administering prescribed analgesia.…”

The analgesic and anti‐haemorrhagic efficacy of platelet‐rich plasma in tonsillectomy: A systematic review and meta‐analysis of randomised controlled trials

“…These pharmacologic interventions can be administered preoperatively, intraoperatively and postoperatively. Multimodal analgesic approach is often recommended 5,12 ; however, additional randomised controlled trials (RCTs) are warranted to better delineate the efficacy and safety matters of such pharmacologic combination therapy to control tonsillectomy‐associated postoperative pain and haemorrhage 5 …”

“…Multimodal analgesic approach is often recommended 5,12 ; however, additional randomised controlled trials (RCTs) are warranted to better delineate the efficacy and safety matters of such pharmacologic combination therapy to control tonsillectomy-associated postoperative pain and haemorrhage. 5 Recently, platelet-rich plasma (PRP) has attained clinical attention in diverse medical fields due to its advantageous capacity in reducing inflammation and pain, as well as prompting wound healing and cell regeneration.…”