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Inadequate pain management and associated morbidity in children at home after tonsillectomy
1Valley Children's Hospital, Frenso, CA, USA.
Insights
Post-tonsillectomy pain is significant in children, with many experiencing inadequate pain relief and side effects. Parents often administer analgesics less frequently than prescribed, contributing to poor outcomes.
Area of Science:
- Pediatric Surgery
- Pain Management
- Ambulatory Care
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Effective pain management is crucial for recovery after tonsillectomy.
- Understanding parental administration of analgesics and child outcomes is important.
Purpose of the Study:
- To assess pain intensity in children after tonsillectomy.
- To evaluate analgesic administration and effectiveness.
- To identify side effects and their association with pain management.
Main Methods:
- Telephone interviews with parents of 84 children within 24 hours of discharge.
- Pain intensity rating scales.
- Data collection on analgesic type, dose, frequency, and side effects.
Main Results:
- Mean pain intensity was 1.42, with worst pain at 1.93.
- Acetaminophen with codeine was the most common analgesic.
- 77% of parents reported adequate pain relief, but 23% did not.
- Common side effects included restless sleep (62%), behavior changes (75%), and difficulty with oral intake (56%).
- 26% experienced emesis.
Conclusions:
- Children experience significant pain post-tonsillectomy.
- Analgesic administration by parents may be less frequent than prescribed.
- Under-treatment of pain and surgery-related factors contribute to adverse effects like poor fluid intake and emesis.
Abstract:
A telephone interview with the parents of 84 children who underwent tonsillectomy was conducted within 24 hours after discharge from an ambulatory surgery center. Parents were asked to rate the intensity of their child's pain and data were collected on the type, dose, and amount of analgesics administered, and the types of side effects the children experienced. The mean age of the children was 7 years (SD = 2.31), with an equal number of boys and girls. Overall mean pain intensity was 1.42 (SD = 0.71) and the worst pain intensity ranged from 0 to 3 (Mean = 1.93; SD = 0.83). Acetaminophen with codeine was the most common analgesic prescribed and administered. Children received an average of 3 doses in the first 24 hours after surgery. Seventy-seven percent of the parents stated that pain relief from the analgesic was adequate. Of the 23% who did not feel that pain control was adequate, only 7% contacted a physician. The majority of the children experienced restless sleep (62%), behavior changes (75%), and difficulty taking oral fluids because of complaints of pain (56%). Twenty-six percent of the children had one or more episodes of emesis. Our data suggest that children experience a significant amount of pain in the first 24 hours after tonsillectomy and that parents administer analgesics less frequently than the drugs are prescribed. In addition, children experience significant deleterious effects (i.e., poor oral fluid intake, sleep disturbance, behavioral changes, and emesis) associated with the undertreatment of pain, the analgesic administered, or the surgery itself.