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

Guntinas‐Lichius, Orlando; Geißler, Katharina; Komann, Marcus; Meißner, Winfried

doi:10.1371/journal.pone.0154155

Cited by 16 publications

(20 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In tonsillectomy, the entire tonsil and its capsule is removed, while in tonsillotomy, only the medial portions of the tonsils are removed, leaving the tonsil capsule intact [17]. Older children reported higher pain levels after tonsillectomy than younger children in line with previous studies [18], but the results should be interpreted with caution because children's perception of pain and the way they behave when in pain is influenced by age and cognitive development [19]. Regarding pain levels, there is a need to clarify that pain is a subjective experience, and an acceptable pain level after tonsil surgery is a matter of the individual child.…”

Section: Discussionsupporting

confidence: 84%

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

Alm

Lundeberg

Ericsson

2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose To explore the severity and duration of postoperative pain, the management of analgesics, and postoperative recovery in children undergoing tonsil surgery. Method Participants included 299 children aged 4–17 years undergoing tonsillotomy ± adenoidectomy (TT ± A) or tonsillectomy ± adenoidectomy (TE ± A). Data were collected up to 12 days. The child rated pain on the Face Pain Scale-Revised (FPS-R) and recovery using the Postoperative Recovery in Children (PRiC) questionnaire. Caregivers assessed their child's pain, anxiety, and nausea on a numeric analog scale and kept a log of analgesic administration. Results High pain levels (FPS-R ≥ 4) were reported in all surgical and age groups (TT ± A age 4–11, TE ± A age 4–11, TE ± A age 12–17), but there were variations in pain intensity and duration within and between groups. The TE ± A group scored more days with moderate to very excruciating pain and lower recovery than the TT ± A group, with the worst outcomes reported by older TE ± A children. The majority of the children used paracetamol + COX-inhibitors at home, but regular administration of analgesics was lacking, particularly during late evening and at night. Few were received rescue medication (opioid or clonidine) despite severe pain. Physical symptoms and daily life activities were affected during the recovery period. There was moderate agreement between child and the caregiver’s pain assessment scores. Conclusion Children reported a troublesome recovery with significant postoperative pain, particularly older children undergoing tonsillectomy. Pain treatment at home was suboptimal and lacked regular analgesic administration. Patient information needs to be improved regarding the importance of regular administration of analgesics and rescue medication.

show abstract

Section: Discussionsupporting

confidence: 84%

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

Alm

Lundeberg

Ericsson

2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…16 Treatment for posttonsillectomy pain is often insufficient or ineffective as evidenced by a recent survey where more than 40% of patients experience severe pain as defined as greater than or equal to 7 out of 10 on a numeric rating scale. 34 The primary focus of this study was neither pain relief nor respiratory depression, but rather the miosis-remifentanil concentration effect relationship in children with and without obstructive sleep apnea. Indeed, it is not possible to extrapolate pupillometry as an explicit and perfect marker for either of these critical clinical endpoints.…”

Section: Discussionmentioning

confidence: 99%

Opioid Sensitivity in Children with and without Obstructive Sleep Apnea

et al. 2019

View full text Add to dashboard Cite

C hildhood obstructive sleep apnea, defined by periodic, partial or complete obstruction of the upper airway during sleep, is a common disorder in pediatric patients, with a prevalence as high as 5.7%. 1,2 Children with obstructive sleep apnea often present for surgery and other procedures that require general anesthesia. In fact, the treatment of obstructive sleep apnea is the primary indication for more than 75% of children undergoing tonsillectomy with or without adenoidectomy. 3 Tonsillectomy is the most common pediatric operation performed in the United States, with more than 500,000 tonsillectomies performed annually. 4 Unfortunately, children at high risk for obstructive sleep apnea are three times more likely to have posttonsillectomy respiratory complications and apneic adverse events than children at low risk for obstructive sleep apnea, 5,6 and the rate of complications in patients with obstructive sleep apnea posttonsillectomy (16 to 27%) is substantially increased compared to that of the general pediatric postoperative population (0 to 1.3%). 7-11 These complications include oxygen desaturation, hypercapnia, obstructive apneas requiring continuous positive airway pressure or airway instrumentation, unexpected intensive care unit admission, and in rare cases, death. Concerns for a heightened risk of opioid induced respiratory depression make the perioperative use of opioids in children with obstructive sleep apnea particularly challenging, if not controversial. It has been suggested that they may be at risk from overdose if administered what would otherwise be considered a normal dose of opioid. 6 Indeed, some pediatric surgical centers automatically reduce by half aBStract Background: Opioids are a mainstay of perioperative analgesia. Opioid use in children with obstructive sleep apnea is challenging because of assumptions for increased opioid sensitivity and assumed risk for opioid-induced respiratory depression compared to children without obstructive sleep apnea. These assumptions have not been rigorously tested. This investigation tested the hypothesis that children with obstructive sleep apnea have an increased pharmacodynamic sensitivity to the miotic and respiratory depressant effects of the prototypic μ-opioid agonist remifentanil. Methods: Children (8 to 14 yr) with or without obstructive sleep apnea were administered a 15-min, fixed-rate remifentanil infusion (0.05, 0.1, or 0.15 μg • kg-1 • min-1). Each dose group had five patients with and five without obstructive sleep apnea. Plasma remifentanil concentrations were measured by tandem liquid chromatography mass spectrometry. Remifentanil effects were measured via miosis, respiratory rate, and end-expired carbon dioxide. Remifentanil pharmacodynamics (miosis vs. plasma concentration) were compared in children with or without obstructive sleep apnea. results: Remifentanil administration resulted in miosis in both nonobstructive sleep apnea and obstructive sleep apnea patients. No differences in the relationship between remifentanil concentra...

show abstract

“…The most significant complication of tonsil surgery is postoperative haemorrhage, which can result in urgent readmission to the hospital, return to the theatre and in rare instances, death 18–20. The procedure is also associated with several days of postoperative pain, and even with the standard use of postoperative analgesics, many patients report significant pain and discomfort 21. The small differences in mean visit rates between the patients who underwent surgery compared with those who did not, together with the low incidence rates of medical care visits in the patients who did not undergo surgery during the follow-up period, imply that the gain of tonsillectomy in the studied population may be questioned.…”

Section: Discussionmentioning

confidence: 99%

Does tonsillectomy reduce medical care visits for pharyngitis/tonsillitis in children and adults? Retrospective cohort study from Sweden

2019

View full text Add to dashboard Cite

ObjectiveTo assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis.DesignRetrospective cohort study.SettingData were retrieved from the VEGA register, a comprehensive regional cohort in Sweden.Participants1044 children (<15 years) and 2244 adults.InterventionTonsillectomy/adenotonsillectomy compared with no surgical treatment.Main outcome measuresChanges in yearly mean rates of medical care visits due to pharyngitis/tonsillitis.ResultsIn children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of −1.80 (−1.90 to −1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was −1.51 (−1.61 to −1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of −0.283 (−0.436 to −0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of −1.30 (−1.36 to −1.24), p<0.0001, compared with −1.18 (−1.24 to −1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was −0.111 (−0.195 to −0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up.ConclusionIn this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value.

show abstract

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

Cited by 16 publications

References 33 publications

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

Opioid Sensitivity in Children with and without Obstructive Sleep Apnea

Does tonsillectomy reduce medical care visits for pharyngitis/tonsillitis in children and adults? Retrospective cohort study from Sweden

Contact Info

Product

Resources

About