Related Experiment Video
Updated: Jun 27, 2025
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Effectiveness of implementing a standardized perioperative pain management protocol in children undergoing
Lauren Freedman1, Anna Varughese1, Binu Koirala2
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, St. Petersburg, Florida, USA.
Insights
Implementing a standardized pain management protocol for pediatric tonsillectomy significantly reduced opioid use and respiratory complications. This approach proved effective and feasible for improving patient outcomes in the Post Anesthesia Care Unit (PACU).
Area of Science:
- Pediatric Anesthesiology
- Surgical Quality Improvement
- Pain Management
Background:
- Inconsistent pain management post-pediatric tonsillectomy leads to varied complications and medication needs.
- Approximately 1000 tonsillectomies are performed annually at our tertiary care facility.
- Variability in postoperative care impacts patient recovery and resource utilization.
Purpose of the Study:
- To evaluate the impact of a standardized perioperative pain management protocol.
- To reduce postoperative complications in pediatric tonsillectomy patients.
- To assess the effectiveness of a new pain management strategy.
Main Methods:
- A pre-post-intervention design compared outcomes before and after protocol implementation over 12 weeks.
- Data collected via Qualtrics surveys by Post Anesthesia Care Unit (PACU) nurses.
- Measured outcomes included pain medication administration, respiratory complications, protocol adherence, and usability.
Main Results:
- The intervention group showed reduced postoperative opioid use (54.5% vs. 93.8%) and IV fentanyl administration (28.3% vs. 49.4%).
- Respiratory interventions and team activations decreased significantly in the intervention group (7.1% vs. 24.7%).
- 100% adherence to the protocol was achieved, with providers reporting ease of use.
Conclusions:
- Standardized perioperative pain management effectively reduced opioid administration and respiratory complications.
- The protocol demonstrated high adherence and usability among healthcare providers.
- Implementing standardized protocols is a feasible strategy to enhance pediatric surgical patient outcomes.
Background And Purpose:
Tonsillectomy procedures are commonly performed worldwide. At our academic tertiary care facility, we perform approximately 1000 tonsillectomy procedures annually. We have found inconsistent pain management strategies in pediatric tonsillectomy patients have contributed to variability in postoperative complications and the number and types of postoperative pain medications required in the Post Anesthesia Care Unit (PACU). This project aimed to assess the impact of implementing a standardized perioperative pain management protocol on reducing postoperative complications in pediatric patients who underwent a tonsillectomy procedure.
Methods:
A pre-post-intervention design was utilized, comparing characteristics and outcomes of pediatric patients for whom a standardized perioperative pain management protocol was implemented over a 12-week period compared to those who did not. The standardized perioperative pain management protocol was utilized intraoperatively by the anesthesiologists, nurse anesthetists, and residents. A Qualtrics survey was used by the Post Anesthesia Care Unit (PACU) nurses to gather data as they cared for patients who underwent tonsillectomy. Four outcomes were measured: (1) postoperative pain medication administration, (2) rate of postoperative respiratory complications, (3) rate of adherence, and (4) usability of a standardized pain management protocol. Data were compared between pre and post-implementation groups.
Results:
During the quality improvement project, 180 children underwent tonsillectomy, with 81 in the control group and 99 in the intervention group. The median age did not differ between groups. The control group had higher postoperative opioid medication usage (93.8% vs. 54.5%) and a higher number of opioids administered in the recovery room. Postoperative IV fentanyl was reduced in the intervention group (49.4% vs. 28.3% in the intervention, p = .004). Respiratory interventions were more frequent in the control group (24.7% vs. 7.1%), with increased respiratory team activation. Respiratory team activation in the Post Anesthesia Care Unit (PACU) includes a 511 page for anesthesia provider assistance. Respiratory interventions included bag-mask ventilation, lidocaine, propofol or succinylcholine administration, and reintubation. The intervention group had 100% adherence to the pain management protocol, and providers found it easy to use.
Conclusion:
The quality improvement project highlighted notable improvements in the intervention group for whom a standardized perioperative pain management protocol was used, including reduced opioid medication administration, lower incidence of respiratory interventions, and high adherence to the pain management protocol. These findings underscore the effectiveness and feasibility of standardized protocols in enhancing patient outcomes.
More Related Videos
Related Concept Videos
01:26Tonsillitis II: Management
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...