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Pain after discharge following head and neck surgery in children
Caroline A Wilson1, David Sommerfield1, Thomas F E Drake-Brockman1,2
1Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.
Insights
Postoperative pain in children varies significantly after head and neck surgeries. Adenotonsillectomy causes the most pain, while other procedures like myringotomy have mild, short-term pain manageable at home.
Area of Science:
- Pediatric Surgery
- Pain Management
- Otolaryngology
Background:
- Children experience significant pain after adenotonsillectomy.
- Limited data exists on pain following other pediatric head and neck surgeries.
Purpose of the Study:
- To describe the severity and duration of postoperative pain in children undergoing elective head and neck procedures.
- To assess secondary outcomes including behavioral disturbance, nausea/vomiting, parental satisfaction, and reattendance rates.
Main Methods:
- Prospective study involving parents of children (0-18 years) undergoing common head and neck operations.
- Pain scores, analgesia use, behavioral changes, and nausea/vomiting were collected via telephone interviews until pain resolved.
Main Results:
- Adenotonsillectomy patients experienced moderate pain for an average of 9 days.
- Other procedures (adenoidectomy, myringotomy, etc.) resulted in mild pain lasting 1-3 days.
- Behavioral issues correlated with pain scores; nausea/vomiting rates were low, and reattendance was 16%.
Conclusions:
- Adenotonsillectomy presents the greatest challenge for pediatric postoperative pain management.
- Most other head and neck surgeries in children result in mild, short-term pain manageable with simple analgesia at home.
- Discharge instructions and analgesia should be tailored to the specific surgical procedure.
Background:
It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations.
Aim:
The aim of this study was to describe the severity and duration of postoperative pain experienced by children undergoing elective head and neck procedures (primary outcomes). Behavioral disturbance, nausea and vomiting, parental satisfaction, and medical reattendance rates were also measured (secondary outcomes).
Method:
Parents of children (0-18 years) undergoing common head and neck operations were invited to participate. Pain scores on the day of surgery and each day post discharge were collected via multiple telephone interviews. Data collected included pain levels, analgesia prescribed and given, behavioral disturbance rates, and nausea and vomiting scores. Follow-up was continued until pain resolved.
Results:
Two hundred and fifty-one patients were analyzed (50 adenoidectomy, 51 adenotonsillectomy, 19 myringoplasty, 52 myringotomy, 43 strabismus, and 36 tongue tie divisions). On the day of surgery myringoplasty, strabismus surgery, and adenotonsillectomy patients on average had moderate pain, whereas adenoidectomy, tongue tie, and myringotomy patients had mild pain. Adenotonsillectomy patients continued to have moderate pain for several days with pain lasting on average 9 days. From day 1 postoperatively mild pain was experienced in the other surgical groups with the average duration of pain varying from 1 to 3 days depending on the surgery performed. Frequency of behavioral issues closely followed pain scores for each group. Analgesic prescribing and regimes at home varied widely, both within and between the different surgical groups. Rates of nausea and vomiting following discharge were low in all groups. The overall unplanned medical reattendance rate was 16%.
Conclusion:
Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.
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