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Pain control following tonsillectomy in children: A survey of patients
Philip R Persino1, Lena Saleh1, David L Walner2
1Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States.
Insights
Pediatric tonsillectomy patients often require hydrocodone for pain management, finding the prescription valuable despite adequate over-the-counter options. Further research is needed on factors influencing narcotic use post-tonsillectomy.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Tonsillectomy is a common pediatric procedure with significant postoperative pain.
- Current pain management strategies lack consensus, compounded by recent FDA warnings on narcotic use.
- Effective pain control is crucial for pediatric recovery after tonsillectomy.
Purpose of the Study:
- To survey pediatric patients and parents regarding pain management after tonsillectomy.
- To assess the utilization and satisfaction with pain medication regimens, including hydrocodone.
- To evaluate the perceived value of an acetaminophen-hydrocodone prescription for post-tonsillectomy pain.
Main Methods:
- Prospective survey of 111 pediatric patients (≤18 years) undergoing tonsillectomy.
- Patients were prescribed alternating acetaminophen/ibuprofen and as-needed acetaminophen with hydrocodone.
- Surveys administered at 2-week follow-up assessed pain levels, medication use, and satisfaction.
Main Results:
- 75.7% of patients/parents used hydrocodone, finding over-the-counter (OTC) medications inadequate.
- No significant differences in pain severity or worst pain day were observed between hydrocodone users and non-users.
- The majority found the hydrocodone prescription valuable, irrespective of their pain control regimen.
Conclusions:
- Pediatric patients and parents perceive acetaminophen-hydrocodone prescriptions as therapeutically valuable for post-tonsillectomy pain.
- Many patients find the prescription necessary for effective postoperative pain management.
- Further investigation is required to identify patient-specific factors influencing narcotic utilization.
Objective:
This prospective study aimed to survey pediatric patients and their parents after tonsillectomy to assess their pain management utilization and satisfaction.
Introduction:
Tonsillectomy is the second most common surgical procedure performed in pediatric patients. Postoperative recovery is often associated with high levels of pain and severe functional limitations. There is currently no consensus on pain control regimens. Additionally, a recent FDA Black Box Warning on narcotic use has caused more uncertainty in appropriate pain control regimens.
Methods:
111 pediatric patients (≤18 years) included in this study underwent tonsillectomy with or without adenoidectomy between October 2013 and August 2015. Postoperatively, each patient/parent was counseled to alternate on an over-the-counter regimen of acetaminophen and ibuprofen and given an additional as-needed acetaminophen with hydrocodone prescription. A survey was administered during the patient's 2-week follow-up that included questions regarding pain levels, worst post-op pain day, pain medications taken during recovery, and patient/parental perceived satisfaction of having the acetaminophen with hydrocodone prescription.
Results:
84 patients/parents (75.7%) felt that OTC medications were not adequate for pain control and used hydrocodone at least once. Between those who took hydrocodone versus those who did not, there was no significant difference in mean age (6.7 ± 2.9 vs. 6.0 ± 2.4 years), percentage of patients with severe pain (36.9% vs. 22.2%) and worst post-op pain day (4.3 ± 1.5 vs. 3.9 ± 1.9 days) (p > 0.05). However, regardless of pain control regimen followed, the majority of patients/parents found it valuable to have the hydrocodone prescription (p = 0.004).
Conclusion:
Post-tonsillectomy patients and their parents find being provided with an acetaminophen-hydrocodone prescription is therapeutically valuable, and many find it necessary in their postoperative pain management. However, further studies are needed to determine patient factors that influence narcotic utilization.
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