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Implementing a standardised discharge analgesia guideline to reduce paediatric post tonsillectomy pain
Fenella R Shelton1, Hirotaka Ishii1, Sophie Mella1
1Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK.
Insights
Implementing a standardized pain management protocol significantly reduced readmissions for pain control after pediatric tonsillectomy. This protocol ensures adequate dosing, improving post-operative recovery for children undergoing tonsillectomy.
Area of Science:
- Pediatric Surgery
- Pain Management
- Clinical Audit
Background:
- Pediatric tonsillectomy is a common UK procedure.
- Inadequate pain control at home frequently leads to hospital readmission.
- Optimizing post-tonsillectomy analgesia is crucial for recovery.
Purpose of the Study:
- To decrease readmission rates due to pain post-pediatric tonsillectomy.
- To evaluate the effectiveness of a standardized analgesic protocol.
Main Methods:
- A retrospective audit of analgesic regimens and readmissions (Sept 2014-Aug 2015).
- Implementation of a standardized weight-based paracetamol dosing protocol for two weeks.
- A second prospective audit cycle (Dec 2015-Nov 2016).
Main Results:
- The initial audit revealed wide variations in analgesic prescriptions and a 7.3% readmission rate for pain.
- Following protocol implementation, readmissions for pain control dropped to 0% (p=0.0027).
- Overall readmission and hemorrhage rates showed no significant change.
Conclusions:
- Existing post-tonsillectomy analgesia practices are inconsistent, often leading to inadequate pain relief.
- A standardized, weight-based analgesic protocol effectively reduces pediatric tonsillectomy readmissions for pain.
- Standardized protocols are vital for optimizing post-operative care.
Objectives:
To reduce readmission for pain control post-paediatric tonsillectomy.
Introduction:
Paediatric tonsillectomy is a common procedure in the UK. Uncontrolled pain at home is a common reason for re-admission and therefore adequate analgesic control following paediatric tonsillectomy is vital for a smooth post-operative recovery. Analgesic regimens at a district general hospital in England were audited and a standardised protocol was subsequently implemented.
Methods:
A retrospective audit from September 2014 to August 2015 was completed. Discharge analgesic regimens and readmission rates post-tonsillectomy for recurrent tonsillitis in 2-17 year-old children were studied in a large general hospital in the United Kingdom. A standardised weight-based algorithm was used to dose scheduled regular paracetamol for 2 weeks. Second cycle prospective audit ran from December 2015 to November 2016.
Results:
In cycle 1, 151 children (mean age, 7.9 years) underwent tonsillectomy for tonsillitis, 25 (16.6%) of whom were readmitted. 12 (7.9%) experienced postoperative haemorrhage, 13 (8.6%) required pain control, and one (1.2%) had infection. The discharging analgesic regimen varied widely and often included purchase of over-the-counter ibuprofen and paracetamol. In cycle 2, 118 children (mean age, 8.8 years) underwent tonsillectomy, 17 (14.4%) were readmitted; 12 (10.2%) had post-operative haemorrhage, 0 needed pain control, 5 (4.2%) had other problems. There was a significant reduction in readmission for pain control (p = 0.0027) from 7.3% to 0% in the study. There was no significant change in overall readmission rate (16.6%-14.4%) or postoperative haemorrhage rate (8.9% overall).
Discussion:
Analgesia prescription post tonsillectomy varies widely and over the counter prescriptions of ibuprofen and paracetamol is based on age rather than weight with patients receiving inadequate analgesic doses. A readily available standardised postoperative analgesic protocol can significantly reduce readmission rates for pain control following paediatric tonsillectomy.
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