Optimale Schmerztherapie nach Tonsillektomie: ein ungelöstes Problem

Abstract

Tonsillectomy is one of the most painful surgical procedures. Unfortunately, it is not unusual that the patient hear statement like: "There is no way around" or "You receive already enough pain killers". Asking the anesthetist or the otorhinolaryngologist, one may get to hear: "Pain after tonsillectomy is not a real problem. We have a reliable pain management protocol". In contradiction, many clinical studies are showing that many patients have persistent and even severe pain after tonsillectomy despite postoperative pain therapy. Considering the results of many controlled clinical trials analyzing manifold varieties of pain management regimes it becomes obvious that there is no standard pain therapy after tonsillectomy with reliable proof of sufficient pain suppression. This review wants to give an overview on the current status of clinical research on pain measurement methods and pain management after tonsillectomy.

Posttonsillectomy Pain Relief and Wound Healing by Applying Bismuth Iodoform Paraffin Paste (BIPP) to Dissected Tonsillar Beds

“…A scheduled oral analgesic dosing regimen was also found to be effective to manage pain in children after tonsillectomy. 6 Several studies have been conducted in the past five years to evaluate the potential advantage of local pain control, that is, using local anesthetics and infiltration techniques at the tonsillar fossa to achieve pain relief after tonsillectomy. One study 27 found that postoperative infiltration and packing at the surgical site with bupivacaine significantly reduced the pain associated with tonsillectomy.…”

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

“…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 – 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 ].…”

“…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 ].…”

Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen

“…Bei einer prospektiven Kohortenstudie in deutschen Krankenhäusern mit mehr als 50 000 Patienten, bei der Schmerzen am ersten postoperativen Tag von 179 chirurgischen Eingriffen verglichen worden waren, fand sich die TE auf Platz 24 [8]. Schmerztherapie nach TE bleibt weltweit ein relevantes Problem bei Erwachsenen und Kindern [9], [10]: In einer schwedischen Registerstudie mit 18 712 Patienten zeigte sich jüngst, dass 20 % der Kinder nach TE schmerzbedingt außerplanmäßig einen Arzt kontaktierten. Die mittlere Dauer der Analgetikatherapie betrug dabei 7,8 Tage [11].…”