Postoperative pain after tonsillectomy – the value of standardized analgesic treatment protocols

Gostian, Antoniu‐Oreste; Loeser, Johannes; Tholen, Christian; Wolber, Philipp; Otte, Martin Sylvester; Schwarz, David; Heindl, Ludwig M.; Balk, Matthias; Gostian, Magdalena

doi:10.1016/j.anl.2020.05.011

Cited by 4 publications

(5 citation statements)

References 43 publications

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“…No respondent prescribed tramadol to children or adolescents and only one provider prescribed it to adults, which is in line with the Swedish guidelines, due to its risk of confusion and respiratory depression [ 17 ], as well as nausea, dizziness, constipation, headache and intoxication [ 22 , 26 , 46 , 47 ]. None of the ENT clinics prescribed codeine for children, which is gratifying since this has been a serious problem in the past [ 21 , 30 , 33 ].…”

Section: Discussionmentioning

confidence: 88%

“…Management of pain following tonsil surgery needs to encompass efficacy and safety in the immediate perioperative period and address pain following discharge after surgery with both pharmacological and nonpharmacological interventions. Significant demands are placed on children, caregivers and adult patients, as they are required to make accurate assessments and to administer the correct analgesic dosages [1,3,5,[16][17][18]. Pain after tonsil surgery is often poorly managed at home, and studies have highlighted problems with inadequate prescription and administration [3,5,16,17,19].…”

Section: Postoperative Pain Managementmentioning

confidence: 99%

“…Significant demands are placed on children, caregivers and adult patients, as they are required to make accurate assessments and to administer the correct analgesic dosages [ 1 , 3 , 5 , 16 – 18 ]. Pain after tonsil surgery is often poorly managed at home, and studies have highlighted problems with inadequate prescription and administration [ 3 , 5 , 16 , 17 , 19 ]. Along with bleeding and dehydration, pain is a common reason for readmission [ 6 , 7 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Pain management after tonsil surgery in children and adults—A national survey related to pain outcome measures from the Swedish Quality Register for tonsil surgery

Roskvist,

Alm,

Nerfeldt

et al. 2024

PLoS ONE

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Objective The primary aim of this study was to describe the current practice regarding pain management in relation to tonsil surgery among Ear Nose and Throat (ENT) clinics in Sweden. The secondary aim was to determine the impact of the provider’s regime of rescue analgesics on the pain related Patient Reported Outcome Measures (pain-PROMs) from the Swedish Quality Register for Tonsil Surgery (SQTS). Materials & methods A descriptive cross-sectional study originating from a validated web-based questionnaire. The survey enrolled one respondent from each ENT clinic (47/48 participated) nationally. Pain-PROMs from the SQTS, recorded from October 2019 to October 2022, were included (8163 tonsil surgeries). Results Paracetamol was used by all enrolled ENT clinics as preemptive analgesia. The addition of COX inhibitors was used in 40% of the clinics. Betamethasone was usually administered, to prevent pain and nausea (92%). All clinics gave postdischarge instructions on multimodal analgesia with COX inhibitors and paracetamol. Rescue analgesics were prescribed after tonsillectomy for 77% of adults, 62% of older children, 43% of young children and less often after tonsillotomy. The most frequently prescribed rescue analgesic was clonidine in children (55%) and oxycodone in adults (72%). A high proportion of patients reported contact with health care services due to postoperative pain (pain-PROMs/ SQTS). Tonsillectomy procedures were associated with the highest rates of contacts (children/adolescents 13–15%; adults 26%), while tonsillotomy were associated with lower rates, (5–7% of children/adolescents). There was no significant difference in the frequency of health care contacts due to pain regarding whether clinics routinely prescribed rescue analgesics or not after tonsillectomy. Conclusion The Swedish analgesic regimen after tonsil surgery is good overall. Nevertheless, there is a need for increased awareness and knowledge to achieve optimal patient recovery. Pain-PROM data demonstrate the call for improvement in pain management after tonsil surgery.

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Section: Discussionmentioning

confidence: 88%

Section: Postoperative Pain Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pain management after tonsil surgery in children and adults—A national survey related to pain outcome measures from the Swedish Quality Register for tonsil surgery

Roskvist,

Alm,

Nerfeldt

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The operation time was measured for each side. The pain was evaluated using the Wong–Baker Pain Scale 24 , 25 (a visual analogue scale [VAS] with a score of 0–10) for each side within 2 h and at 1, 2, and 4 weeks postoperatively. Patients who were not informed to which side received which monopolar settings, were asked about their pain level on each side as follows: “On a scale of 0 to 10, where 0 indicates no pain and 10 represents the most severe pain you have ever experienced, what is your pain score?”.…”

Section: Methodsmentioning

confidence: 99%

Effect of monopolar diathermy power settings on postoperative pain, wound healing, and tissue damage after tonsillectomy: a randomized clinical trial

Yun,

Jang,

Shin

et al. 2024

Sci Rep

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This study aimed to assess the impact of varying monopolar diathermy power settings on postoperative pain, hemorrhage, and wound healing following tonsillectomy. A single-center, prospective, randomized, double-blinded, controlled clinical study was conducted. During bilateral tonsillectomy procedures, one tonsil received low-power settings (15 W, cutting/blend) while the other tonsil received high-power settings (35 W, cutting/blend). Postoperative pain scores (0–10) and wound healing scores (0–3) were evaluated immediately after surgery and at 1, 2, and 4 weeks postoperatively using the visual analog scale. Additionally, histological analysis was performed on electrically resected tonsil tissues to assess tissue damage in the tonsil bed. The allocation of high and low power settings to each side was randomized. Results showed that 1 week after the surgery, the high-power group experienced significantly higher pain scores (mean ± standard deviation: 4.84 ± 2.21) compared to the low-power group (3.56 ± 2.24, p = 0.049). Moreover, the high-power side exhibited slower wound healing during the initial 1–2 weeks postoperatively, as indicated by lower wound scores at 2 weeks (high-power: 1.96 ± 0.64; low-power: 2.43 ± 0.59, p = 0.008). Furthermore, histological analysis revealed significantly deeper tissue degradation on the high-power side compared to the low-power side (p < 0.001), with mean depths of 565.2 ± 291.0 µm and 156.0 ± 36.8 µm, respectively. In conclusion, these findings suggest that when employing monopolar diathermy in tonsillectomy, lower power settings can lead to improved outcomes in terms of postoperative pain, wound healing, and tissue damage.Trial registration: CRIS identifier: KCT0005670 (cris.nih.go.kr, registration date: 11/12/2020).

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“…Sample size estimation was performed for the primary endpoint maximum and average pain perception and was based on Gostian et al (2020). 14 Here, two standardized analgesic treatment protocols were compared regarding postoperative pain perception after tonsillectomy. A medium sized effect was found for maximum pain (f = 0.251) and pain on ambulation (f = 0.223).…”

Section: Methodsmentioning

confidence: 99%

Analgesia after tonsillectomy with controlled intravenous morphine — overdue or exaggerated?

Gostian¹,

Loeser²,

Bentley³

et al. 2023

Brazilian Journal of Otorhinolaryngology

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Postoperative pain after tonsillectomy – the value of standardized analgesic treatment protocols

Cited by 4 publications

References 43 publications

Pain management after tonsil surgery in children and adults—A national survey related to pain outcome measures from the Swedish Quality Register for tonsil surgery

Pain management after tonsil surgery in children and adults—A national survey related to pain outcome measures from the Swedish Quality Register for tonsil surgery

Effect of monopolar diathermy power settings on postoperative pain, wound healing, and tissue damage after tonsillectomy: a randomized clinical trial

Analgesia after tonsillectomy with controlled intravenous morphine — overdue or exaggerated?

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