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Published on: November 6, 2019
Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children
Kristy M J Vons1, Jilles B Bijker, Edwin W Verwijs
1Department of Anesthesia, Gelderse Vallei Hospital, Ede, The Netherlands.
Insights
Postoperative pain management for children undergoing adenoidectomy (AD) and adenotonsillectomy (ATE) shows significant differences. While AD patients managed well with acetaminophen, ATE patients experienced considerable pain for up to two days despite multimodal analgesia.
Area of Science:
- Pediatric surgery
- Pain management
- Anesthesiology
Background:
- Adenoidectomy (AD) and adenotonsillectomy (ATE) are common pediatric surgical procedures.
- Postoperative pain following ATE is often challenging to manage effectively in children.
- Evaluating pain prevalence and severity in ambulatory AD and ATE is crucial.
Purpose of the Study:
- To assess the prevalence and severity of postoperative pain in children undergoing AD and ATE.
- To compare pain experiences between AD and ATE procedures in a day-care setting.
Main Methods:
- A prospective cohort study included 167 children (0-12 years) undergoing AD or ATE.
- Pain was assessed using FLACC, PPPM, and VAS scales.
- Children received varying analgesic regimens, including acetaminophen, diclofenac, and sufentanyl.
Main Results:
- Children undergoing AD reported lower pain scores (VAS=1) than ATE patients (VAS=2) upon discharge.
- At home, ATE patients reported higher pain (VAS=4.5, PPPM=9) compared to AD patients (VAS=2.0, PPPM=1.5).
- AD patients normalized activities in 2 days, while ATE patients required 7 days.
Conclusions:
- Acetaminophen alone is sufficient for pain management after AD.
- Children undergoing ATE experience significant pain for up to two days, even with acetaminophen and diclofenac.
- Optimized pain protocols are needed for pediatric ATE.
Background:
Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting.
Methods:
A prospective cohort study was performed including 167 children aged 0-12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre- and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around-the-clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability-scale (FLACC), as well as during a 1-week follow-up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores.
Results:
All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively.
Conclusion:
Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.
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