Perioperative Pain Management Strategies and Postoperative Outcomes in Tonsillectomy Patients Aged Seven to 14 Years:...

Background Tonsillectomy is a common pediatric procedure requiring effective perioperative pain management to minimize complications and promote recovery. In resource-limited settings, standardized protocols are often challenged by infrastructural constraints and variable adherence to multimodal analgesia guidelines, risking suboptimal pain control and delayed discharge. Objective To evaluate a standardized acetaminophen-based pain management protocol and its impact on postoperative outcomes in children aged seven to 14 years undergoing tonsillectomy at the Lady Reading Hospital, a tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, Pakistan. Methods A prospective observational study was conducted at Lady Reading Hospital, Peshawar, between October 2024 and July 2025. Data from 99 consecutively enrolled patients were collected using a structured proforma, capturing demographics, perioperative medications, pain scores (Numeric Rating Scale 0-10 or Wong-Baker Faces scale), discharge status, oral intake tolerance, and pain at discharge. The analgesic protocol was primarily acetaminophen-based. Patients received intraoperative acetaminophen, with ibuprofen administered postoperatively as needed for breakthrough pain. A single dose of tramadol was given at induction as part of the standard anesthesia protocol. Descriptive statistics were analyzed using SPSS version 25. Ethical approval was obtained from the hospital research committee. Results All 99 patients (100%) received uniform intra-/post-operative acetaminophen (15 mg/kg). Adjunct ibuprofen, as rescue analgesia (PRN), was administered to only six out 99 (6.1%) of patients, whose pain did not subside. Postoperative pain scores revealed that 73.7% (73/99) of the patients reported mild pain (score=3 on the 0-10 pain scale), while 20.2% (20/99) of the patients reported moderate pain (score=5 on the 0-10 pain scale), with the latter predominantly observed in younger children (seven to nine years). All patients 99/99 (100%) tolerated cold liquids orally. Although no patient (0/99) reported pain at discharge (assessed as a binary Yes/No field by nursing staff at time of discharge; not a formal repeated pain score), while 73.7% (73/99) were discharged home after 24 hours, with retention rates peaking among 26/99 (26.3%) patients aged 11-year-olds. Conclusion A standardized perioperative acetaminophen-based monotherapy was associated with generally low pain scores and favorable recovery outcomes, including high rates of oral intake tolerance and minimal pain at discharge in this cohort. However, a proportion of patients still experienced moderate pain, which may be related to the limited use of ibuprofen. Given the observational design and absence of a control group, these findings should be interpreted with caution. Further controlled studies are needed to compare analgesic strategies and to determine the optimal role of adjuncts such as ibuprofen and age-specific dosing. Additionally, system-level factors influencing timely discharge warrant further investigation.