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Pain in children undergoing tonsillotomy with alternating ibuprofen and paracetamol - a prospective observational

Philipp Gude1, Niclas Geldermann1, Adrian I Georgevici1

  • 1Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Germany.

Acta Anaesthesiologica Scandinavica
|July 26, 2021
PubMed

Insights

Standard pain therapy using alternating ibuprofen and paracetamol for pediatric tonsillotomy patients shows effectiveness after postoperative day one, but requires improvement for the day of surgery. Pain management in children needs further optimization.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Otolaryngology

Background:

  • Optimal pain management following pediatric tonsillotomy is not well-established.
  • This study evaluated a pain therapy regimen involving alternating ibuprofen and paracetamol.

Purpose of the Study:

  • To assess the efficacy of a standard pain therapy regimen.
  • To determine the need for opioid rescue medication (RM) in children post-tonsillotomy.
  • To analyze pain scores, scale concordance, and adverse events.

Main Methods:

  • 81 pediatric patients (2-12 years) undergoing tonsillotomy were monitored.
  • Pain intensity was assessed using the Children's and Infants' Postoperative Pain Scale (CHIPPS) and Faces Pain Scale-Revised (FPS-R).
  • Parents utilized the Parents' Postoperative Pain Measure (PPPM-D); exceeding thresholds indicated need for RM.

Main Results:

  • 45.7% of children required RM, with 30.9% needing it on the ward.
  • The highest incidence of pain requiring RM was on the day of surgery (32.1%).
  • Fever occurred in 13.6% of children, potentially confounding pain measurements.

Conclusions:

  • The alternating ibuprofen and paracetamol regimen was effective from postoperative day one but needs refinement for the day of surgery.
  • Low concordance was observed between the PPPM-D and CHIPPS/FPS-R pain scales.
  • Fever may impact pain intensity assessment, particularly with the PPPM-D.
Abstract

Keywords:
CHIPPSacute painchildfaces pain scale revisedotolaryngologypain intensity assessmentparents´ postoperative pain measure

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