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

Abstract

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.

Establishment of resilience in a challenging recovery at home after pediatric tonsil surgery—Children’s and caregivers’ perspectives

“…The caregivers lacked any options other than ibuprofen and paracetamol to give when the pain was at its worst. The need for rescue analgesics was also identified in the quantitative data from this population 4 . Opioids, particularly products containing codeine, have traditionally played a role in pain treatment after tonsillectomy 29,30 .…”

“…Participants were selected from a cohort (aged 4‐17 years) included in an observational study that used a pain diary to explore postoperative pain, pain management, and recovery at home after tonsil surgery 4 . Families from three hospitals were informed of the possibility to participate in an interview 2‐4 weeks after surgery.…”

“…Although tonsil surgery is associated with health benefits, 1,2 a child undergoing tonsil surgery is emotionally and physically affected throughout the process, not least postoperatively affected by pain and pain-related complications. 3,4 There are two surgical methods in tonsil surgery practice: tonsillectomy and tonsillotomy. In tonsillectomy, the entire tonsil is removed, including its capsule, while tonsillotomy involves surgical removal of the majority of the tonsillar tissue without violating the capsule.…”

“…The primary indications are upper airway obstruction related to tonsillar hypertrophy and recurrent tonsillitis. Although tonsil surgery is associated with health benefits, 1,2 a child undergoing tonsil surgery is emotionally and physically affected throughout the process, not least postoperatively affected by pain and pain‐related complications 3,4 …”

Pharmacologic management of post‐tonsillectomy pain in children

“…Of note, this same study showed nearly 50% still experiencing significant pain on postoperative day 7. A more recent study by Alm et al 60 similarly showed high levels of child pain with roughly 20% of parents underestimating their child's pain, and only about half of patients receiving the recommended number of scheduled doses of acetaminophen each day on days 1–3, and only one third receiving the prescribed number of doses of ibuprofen.…”