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[Prevention and control of pain in (adeno)tonsillectomy]
W J Boelen-van der Loo1, F G Driessen
1Emma Kinderziekenhuis/Het Kinder AMC, Amsterdam.
Insights
Postoperative pain after tonsillectomy is severe, even with preventive analgesia. Higher doses of paracetamol and codeine showed better pain relief 3-6 hours after surgery. Further research into anesthetic techniques is recommended.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Otolaryngology
Background:
- Postoperative pain following adenotonsillectomy is a significant clinical challenge in pediatric care.
- Effective pain management is crucial for patient recovery and parental satisfaction.
Purpose of the Study:
- To evaluate the efficacy of three different analgesia protocols for preventing and treating pain in children undergoing adenotonsillectomy.
- To compare the effectiveness of paracetamol alone versus paracetamol combined with codeine.
Main Methods:
- A study involving 64 children (15-25 kg) undergoing adenotonsillectomy.
- Three protocols were administered preoperatively and every 4 hours: Protocol I (240mg paracetamol), Protocol II (500mg paracetamol), and Protocol III (500mg paracetamol + 10mg codeine), all in suppository form.
- Pain was assessed using the Oucher test by the children at 1, 3, and 6 hours postoperatively.
Main Results:
- One hour postoperatively, no significant difference in pain scores was observed among the three groups.
- Significant differences in pain reduction were noted at 3 and 6 hours, with Protocols II and III demonstrating better analgesia than Protocol I.
- Protocol III (paracetamol + codeine) showed comparable or slightly better pain relief than Protocol II (higher dose paracetamol) at later time points.
Conclusions:
- Children experience severe pain immediately after adenotonsillectomy, despite preventive analgesia.
- Higher doses of paracetamol and the addition of codeine improve postoperative pain management.
- Consideration of modifications to anesthetic techniques may be necessary for optimal pain prevention and suppression.
Abstract:
Pain prevention and analgesia in (adeno)tonsillectomy OBJECTIVE. To study the efficacy of three analgesia protocols in children subjected to (adeno)tonsillectomy. SETTING. Twenteborg District Hospital, Almelo, the Netherlands. PATIENTS AND METHODS. In 64 children with body weights ranging from 15 to 25 kg (mean 20.4 kg) subjected to (adeno) tonsillectomy according to the procedure most current in the Netherlands (according to Sluder with administration of a volatile anaesthetic without intubation in day treatment), three protocols for preventing and treating postoperative pain were applied, with the analgetics most current in the Netherlands. Permission from the Medical Ethical Committee and written informed consent from the parents were obtained. According to protocol I 240 mg paracetamol was given, according to protocol II, 500 mg paracetamol and according to protocol III, 500 mg paracetamol plus 10 mg codeine, in suppository form, every 4 hours always starting 60 minutes before operation. Initially, protocol I was carried out, subsequently randomization of protocols II and III. After a pilot study use of a control group was omitted for ethical reasons because of the severe pain in a placebo group. MEASUREMENTS. The efficacy of the analgesia was evaluated by means of pain assessments by the children themselves using the Oucher test, 1, 3 and 6 hours after operation. The statistical processing of the children's pain scores was performed primarily in a descriptive sense, with simultaneous comparison of the three groups using a single variance analysis for comparison of several groups. Multiple comparisons were carried out according to Ducans' multiple range test. The level of significance was put at p less than or equal to 0.05. RESULTS. One hour postoperatively there was no significant difference among the mean pain scores (0: no pain and 10: very bad pain) of the three groups, viz. 5.2 (SD 3.0), 4.7 (SD 2.9) and 4.7 (SD 2.3), respectively; three hours postoperatively there was a significant difference between the mean pain scores of group I (4.5; SD 2.4) and group II (2.7; SD 2.4) but not between group I and group III (3.3; SD 1.5); six hours postoperatively there was a significant difference between the mean pain scores of group I (4.1; SD 2.1) on the one hand and of groups II (2.1; SD 1.5) and III (2.6; SD 1.6) on the other. CONCLUSION. The findings indicate existence of violent pain immediately after recovery from anaesthesia after (adeno)tonsillectomy as shown by the pain assessments by the children themselves one hour postoperatively, in spite of preventive administration of a high dose of a 'minor' analgetic according to each of the three protocols. Modification of the anaesthetic technique should be considered to effect adequate prevention or suppression of pain.