Guidelines (short version) of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (SFORL) for the management of post-tonsillectomy pain in adults

Paganelli, A.; Khalfallah, S. Ayari; Brunaud, A.; Constant, Isabelle; Deramoudt, V.; Fayoux, P.; Mareau, Charles; Marianowski, R.; Michel, J.; Mondain, M.; Schultz, P.; Tréluyer, J.M.; Wood, Chantal; Pondaven, S.; Nicollas, R.

doi:10.1016/j.anorl.2014.05.003

Cited by 16 publications

(9 citation statements)

References 34 publications

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“…Thus, most guidelines have been modified. Indeed, Swedish [4] and French [5] guidelines recommend NSAIDs as a first line treatment after tonsillectomy. Similar to NSAIDs, dexamethasone was once incriminated as increasing postoperative bleeding [162].…”

Section: Discussionmentioning

confidence: 99%

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PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure-specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta-analysis guidelines with procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol; non-steroidal anti-inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra-operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first-line analgesics are contra-indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.

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Section: Discussionmentioning

confidence: 99%

“…Thus, the ideal regimen providing adequate analgesia with few side‐effects after tonsillectomy remains to be defined. Guidelines on pain management after tonsillectomy have previously been published [4, 5].…”

Section: Introductionmentioning

confidence: 99%

PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…The present study suggests that many patients do not receive adequate or underdosed pain management after tonsillectomy. Several high-quality clinical practice guidelines based on results of controlled clinical trials for post-tonsillectomy pain management have been published for children and adults [ 4 , 28 – 30 ]. They all recommend maintaining adequate analgesia, especially on the first postoperative days.…”

Section: Discussionmentioning

confidence: 99%

Inter-Hospital Variability of Postoperative Pain after Tonsillectomy: Prospective Registry-Based Multicentre Cohort Study

et al. 2016

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ObjectivesAlthough tonsillectomy is one of the most frequent and painful surgeries, the association between baseline and process parameters and postoperative pain are not fully understood.MethodsA multicentre prospective cohort study using a web-based registry enrolled 1,527 women and 1,008 men aged 4 to 85 years from 52 German hospitals between 2006 and 2015. Maximal pain (MP) score the first day after surgery on a numeric rating scale (NRS) from 0 (no pain) to 10 (MP) was the main outcome parameter.ResultsThe mean maximal pain score was 5.8±2.2 (median 6). Multivariable analysis revealed that female gender (Odds ratio [OR] = 1.33; 95% confidence interval [CI] = 1.12 to 1.56; p = 0.001), age <20 years (OR = 1.56; CI = 1.27 to 1.91; p<0.0001), no pain counselling (OR = 1.78; CI = 1.370 to 2.316; p<0.001), chronic pain (OR = 1.34; CI = 1.107 to 1.64; p = 0.004), and receiving opioids in recovery room (OR = 1.89; CI = 1.55 to 2.325; p<0.001) or on ward (OR = 1.79; CI = 1.42 to 2.27; p<0.001) were independently associated with higher experienced maximal postoperative pain (greater the median of 6). The effect of age on pain was not linear. Maximal pain increased in underage patients to a peak at the age of 18 to 20 years. From the age of ≥20 years on, maximal pain after tonsillectomy continuously decreased. Even after adjustment to all statistically important baseline and process parameters, there was substantial variability of maximal pain between hospitals with a heterogeneity variance of 0.31.ConclusionMany patients seem to receive insufficient or ineffective analgesia after tonsillectomy. Further research should address if populations at risk of higher postoperative pain such as females, younger patients or those with preexisting pain might profit from a special pain management protocol. Beyond classical demographical and process parameters the large variability between different hospitals is striking and indicates the existence of other unknown factors influencing postoperative pain after tonsillectomy.

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“…It concluded that instructions given by otolaryngologists varied significantly from clinic to clinic and within centers from surgeon to surgeon. 15…”

mentioning

confidence: 99%

Comparing Cold/Liquid Diet vs Regular Diet on Posttonsillectomy Pain and Bleeding

Faramarzi

Safari

Roosta

2018

Otolaryngol.--head neck surg.

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Objective Tonsillectomy is a common operation; however, there are controversial opinions regarding the posttonsillectomy diet. The aim of this study was to compare the effects of cold/liquid diet vs regular diet on posttonsillectomy pain and bleeding. Study Design Prospective randomized controlled trial. Setting Tertiary referral center. Subjects and Methods In total, 194 children who underwent tonsillectomy (with or without adenoidectomy) were randomly allocated into 2 groups. A total of 100 patients were allocated in the cold/liquid diet, and 94 patients were allocated in the regular diet group. Pain score was recorded for the first 7 days, and rate of hemorrhage was recorded for 10 days after surgery. Results The participants' age range was 3 to 17 years. The mean pain score level in the regular diet group after breakfast, lunch, and dinner was not statistically significant in comparison with the cold/liquid diet group. One patient in the regular diet group was admitted to the hospital due to secondary bleeding, but it stopped without any intervention. Conclusion Most otolaryngologists believe in dietary restrictions following tonsillectomy. However, there is much controversy regarding posttonsillectomy dietary advice in the literature. In addition, only a few randomized clinical trials have focused on this subject. We found that there was no difference between regular diet and cold/liquid diet in terms of posttonsillectomy pain and bleeding. Hence, we do not recommend a limited posttonsillectomy diet.

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Guidelines (short version) of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (SFORL) for the management of post-tonsillectomy pain in adults

Cited by 16 publications

References 34 publications

PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

Inter-Hospital Variability of Postoperative Pain after Tonsillectomy: Prospective Registry-Based Multicentre Cohort Study

Comparing Cold/Liquid Diet vs Regular Diet on Posttonsillectomy Pain and Bleeding

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