Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Alm, Fredrik; Stalfors, Joacim; Nerfeldt, Pia; Ericsson, Elisabeth

doi:10.1007/s00405-017-4679-4

Cited by 26 publications

(26 citation statements)

References 45 publications

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“…Older children and those with recurrent tonsillitis may experience greater pain than young children with obstruction. [24][25][26][27][28] In this study, 22 children were older than 6 years (14 and 8 in the LTD and ES groups, respectively) and 13 children had recurrent tonsillitis (6 and 7 in the LTD and ES groups, respectively). Thus, it is unlikely that older age or diagnosis explains the greater pain medication use in the ES group.…”

Section: Discussionmentioning

confidence: 76%

Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery

et al. 2019

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This was a randomized controlled trial of low thermal damage device versus traditional electrosurgery in children 3 to 17 years old with a clinical diagnosis of sleep disordered breathing, obstructive sleep apnea with adenotonsillar hypertrophy, or recurrent adenotonsillitis. Pain score (Wong-Baker FACES pain scale) was recorded each morning before eating, drinking, or administering pain medication for 14 days postoperatively. Seventy-five children were enrolled. There was no difference in the rate of decrease in pain scores. A significant interaction between rate of pain decrease and number of pain medication doses was present (P < .0001). Median number of pain medication doses was greater with electrosurgery (36, range: 7-49) versus low thermal device (21, range: 2-124; P ¼ .001). Pain scores reached 0 after a median of 7 days (95% confidence interval [CI], 5.2-8.6) for low thermal device and 9 days (95% CI, 8.0-10.0) for electrosurgery (P ¼ .67). One child randomized to electrosurgery was withdrawn due to hospitalization for postoperative bleed. In children, low thermal device results in significantly less pain medication used during the postoperative period than electrosurgery.

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Section: Discussionmentioning

confidence: 76%

Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery

et al. 2019

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“…This corresponds to previous literature which has shown that older children may experience more pain, as well as increased analgesic use and delayed return to day-to-day functioning than younger children following T&A surgery. [44,45] Since UE dyads were of higher age, on average, 336 it is worthwhile to provide specific instructions to parents of older children on potentially higher 337 pain rates. Ultimately, is of most critical importance to provide concrete directions to all parents on identifying and treating child postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Children and their parents’ assessment of postoperative surgical pain: Agree or disagree?

Kaminsky

Fortier

Jenkins

et al. 2019

International Journal of Pediatric Otorhinolaryngology

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Objective: The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. Methods: This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 hours. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain). Results: A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1-3 (30.05%-35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24-26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA 19 demonstrated that parents in the overestimator group administered higher, though still within safe 20 limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement 21 groups. Multiple regression models showed hospital site as the only independent predictor for 22 postoperative pain rating disagreement between children and parents. 23 2 Conclusions: Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.

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“…It can be assumed that families who had the organizational strength to complete and return the diary also had better adherence to analgesic treatment compared to families who did not return the diary. However, some results (duration of analgesics) were similar to randomized controlled trials (RCTs) and register studies [10,17]. The present study did not include highly sensitive measures to identify the impact of different analgesic regimens (e.g., clonidine), which is why there is still no consensus as to the most effective postoperative pain control regimen after tonsil surgery.…”

Section: Discussionmentioning

confidence: 72%

“…2). There was no significant difference in the percentage of child-parent disagreement between the older and younger children (ages 12-17 vs. [4][5][6][7][8][9][10][11]. A weighted kappa analysis of all child-parent pain assessments during days 1-3 resulted in a kappa coefficient of 0.57.…”

Section: Severity and Duration Of Postoperative Painmentioning

confidence: 85%

“…Despite clinical care guidelines, many children continue to experience unnecessary postoperative pain [7]. Data from the National Tonsil Surgery Registry in Sweden shows a high frequency of unplanned health care contacts due to undertreated pain [10]. The pain outcome may depend on the families' compliance with the administration of analgesics.…”

Section: Introductionmentioning

confidence: 99%

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

Alm

Lundeberg

Ericsson

2020

Eur Arch Otorhinolaryngol

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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.

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Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Cited by 26 publications

References 45 publications

Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery

Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery

Children and their parents’ assessment of postoperative surgical pain: Agree or disagree?

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

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