Related Experiment Video
Updated: Jan 16, 2026
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
A Quality Improvement Initiative to Improve Early Postoperative Pain Outcomes After Tonsillectomy in Children
Alfonso Ernesto Albornoz1, Lara Navarro2, Julia Mallen2,3
1Department of Anesthesia, HOMI Hospital Pediatrico de la Misericordia, Bogota, Colombia.
Insights
Implementing a tonsillectomy toolkit significantly reduced moderate to severe postoperative pain in pediatric patients. This intervention improved pain management without increasing adverse events, enhancing recovery after tonsillectomy.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Outcomes
Background:
- Opioid use during pediatric tonsillectomy is often avoided to prevent respiratory complications.
- This avoidance can lead to increased postoperative pain and the need for rescue opioid doses in the postanesthesia care unit (PACU).
Purpose of the Study:
- To decrease moderate to severe PACU pain by 50% in pediatric tonsillectomy/adenotonsillectomy patients within 12 months.
- To evaluate the effectiveness of a standardized toolkit for pain management.
Main Methods:
- Collected pilot data on intraoperative care and PACU pain outcomes (June 2018-June 2020).
- Designed and implemented a six-item tonsillectomy toolkit (April 2021).
- Analyzed data using statistical process control charts, categorizing patients by toolkit adherence.
Main Results:
- Baseline: 65.8% of patients experienced moderate to severe PACU pain.
- Post-toolkit (100% adherence): Moderate to severe pain reduced to 47.1% (28% reduction) in year one, and 31% (53% overall reduction) in subsequent years.
- Rescue opioid use in PACU decreased from 69% pre-toolkit to 35% (49% reduction) in year one (100% adherence group).
Conclusions:
- The tonsillectomy toolkit effectively reduced early postoperative pain by 28% in the first year, with sustained reductions to 53% overall.
- The intervention proved sustainable and did not increase postoperative respiratory adverse events (PRAEs), nausea/vomiting, or PACU length of stay.
- Implementation of the toolkit significantly improved pain management in pediatric tonsillectomy patients.
Background:
Intraoperative opioid use during pediatric tonsillectomy is commonly avoided to reduce the risk of postoperative respiratory adverse events (PRAEs). Avoidance of perioperative opioids may contribute to increased early postoperative pain, which can result in patients receiving rescue doses of opioids in the postanesthesia care unit (PACU).
Aims:
The aim of this project was to reduce moderate to severe pain in PACU for pediatric tonsillectomy/adenotonsillectomy patients by 50% within 12 months.
Methods:
Pilot data was collected on the intraoperative care and PACU pain outcomes of patients between June 2018 and June 2020. A six-item toolkit was designed, then implemented from April 2021, with identical data points collected for comparison. Postintervention patients were categorized into toolkit compliance groups: (1) Standard of care (< 5 of 6 items delivered), (2) Partial Toolkit (5 of 6 items delivered), and (3) Toolkit (100% adherence). Statistical process control charts were used for data analysis.
Results:
Data was collected for 420 patients. Baseline data reported 65.8% of patients experienced moderate-severe pain in PACU. In the first 12 months of toolkit implementation (2021-2022), the incidence of moderate to severe pain decreased to 47.1% in the 100% adherence group (28% reduction). In subsequent years (2022-2024), this measure decreased further to 31% (53% reduction overall). Pretoolkit, 69% of patients received rescue opioids in PACU. In the first 12 months of toolkit implementation (2021-2022), the incidence of rescue opioids in PACU decreased to 35% in the 100% toolkit adherence group (49% reduction). From 2022 to 2024, this decreased to 45% (35% reduction).
Conclusion:
Through the implementation of the tonsillectomy toolkit, we helped reduce early postoperative pain by 28% in the first year. Continued data collection showed the intervention to be sustainable and delivered subsequent decreases in moderate to severe pain by a factor of 53%. These improvements were achieved without increasing PRAEs, postoperative nausea/vomiting incidence, or PACU length of stay.
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,...
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required