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Published on: November 6, 2019
Pain management after tonsillectomy: morphine is not enough
Estelle Vallée1, Sylvie Lafrenaye, Jean-Pierre Tétrault
1Department of Pediatrics, University of Sherbrooke, Sherbrooke, QC, Canada.
Insights
A parental guide for pediatric post-tonsillectomy pain management showed no significant difference in pain scores but was well-received. The study suggests revisiting the acetaminophen-morphine combination for better pain control.
Area of Science:
- Pediatric Surgery
- Pain Management
- Clinical Trials
Background:
- Tonsillectomy is a common day surgery procedure.
- Parents often require support in managing their child's postoperative pain.
- A parental guide was developed to aid in pain evaluation and management.
Purpose of the Study:
- To enhance pediatric post-tonsillectomy pain management.
- To evaluate the effectiveness of a parental guide and treatment algorithm.
Main Methods:
- A randomized clinical trial involved 80 children (5-17 years).
- Participants were assigned to a control or experimental group.
- The experimental group received a treatment algorithm alongside standard care and pain assessment tools (visual analogue scale - VAS).
Main Results:
- Both groups received acetaminophen and morphine for pain relief.
- Pain scores were comparable between the control and experimental groups across different time points.
- No significant differences in side effects or analgesic use were observed.
Conclusions:
- The parental guide was appreciated by parents and children.
- The visual analogue scale (VAS) was easily understood and utilized by children.
- The current acetaminophen-morphine combination may require reevaluation for optimal pain management after tonsillectomy.
Introduction:
Tonsillectomy is usually done as day surgery, transferring to the parents most of the postoperative care. They often feel alone and incompetent in front of a child in pain. We developed a guide to help parents for both the evaluation and the management of postoperative pain.
Objective:
To improve pediatric posttonsillectomy pain management with the implementation of a parental guide and treatment algorithm.
Methods:
Eighty children (5-17 years) were recruited in this randomized clinical trial. Parents and children were assigned to one of the research groups: control or experimental. All received an identical prescription for acetaminophen (15 mg/kg) and morphine (0.3 mg/kg), information about the medication, a visual analogue scale (VAS), and index cards to be filled at home. The experimental group also received a treatment algorithm associating pain scores with analgesics.
Results:
Pain scores for the control group and the experimental group were 5.3 and 4.7 on the day of surgery, 4.0 and 3.6 the next day, 2.2 and 2.3 3 days later, and 1.6 and 1.4 1 week after the intervention, respectively. The side effects and the analgesics given were comparable for both groups.
Conclusion:
No significant difference was demonstrated for the studied parameters, probably because the majority of the parents followed the prescriptions well. The guide was much appreciated. The children understood the VAS easily and liked using it. The combination of acetaminophen-morphine needs to be revisited since pain remains problematic.
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Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
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