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Pain progression, intensity and outcomes following tonsillectomy
13-132 Clinical Sciences Building, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada.
Insights
Pediatric tonsillectomy causes significant pain lasting over a week, often poorly managed. Bupivacaine infiltration unexpectedly increased early pain, leading to more healthcare visits.
Area of Science:
- Pediatric Surgery
- Pain Management
- Anesthesiology
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative pain is a significant concern following tonsillectomy.
- Day surgery models aim to improve efficiency but require careful pain management.
Purpose of the Study:
- To evaluate the outcomes of pediatric day surgery tonsillectomy.
- To assess the extent, duration, and management of postoperative pain.
- To investigate the impact of pain on healthcare utilization.
Main Methods:
- A cohort of 129 children (aged 5-16) undergoing day surgery tonsillectomy were studied.
- Pain was assessed using a visual analogue scale (VAS) for 7 days post-surgery.
- Parents reported on fluid intake, nausea, vomiting, sleep, and analgesic use.
Main Results:
- Tonsillectomy resulted in considerable pain lasting longer than 7 days, with peak intensity in the first 3 days.
- Postoperative pain management by healthcare professionals and parents was generally inadequate.
- Bupivacaine infiltration of the tonsil fossa during surgery correlated with increased pain on the evening of surgery.
Conclusions:
- Pediatric tonsillectomy is associated with prolonged and significant postoperative pain.
- Current pain management strategies for pediatric tonsillectomy are often insufficient.
- Persistent pain leads to increased unscheduled medical visits, particularly between postoperative days 4 and 7.
Abstract:
The objective of this study was to assess outcomes of pediatric day surgery tonsillectomy. A total of 129 children, aged 5-16 years, and their parents were recruited from three urban hospitals which provided pediatric day surgery. Children reported pain on a visual analogue scale (VAS) in day surgery and then daily at home for 7 days. Parents reported outcomes of surgery, including fluid intake, nausea, vomiting and sleep disturbances. They also recorded analgesic administration. Three main results related to extent and duration of pain, quality of management of pain, and effect of pain on utilization of health services. Tonsillectomy caused considerable pain which lasted more than 7 days. Pain followed a trajectory of intense or moderately intense pain for the first 3 days followed by a gradual decline over the next 4 days. In general, post-tonsillectomy pain was poorly managed by health professionals and parents. An unexpected observation was that children who had a bupivacaine infiltration of the tonsil fossa during surgery had significantly more pain in the evening of surgery than children who did not have an infiltration. The increase in postoperative pain experienced by those who had the infiltration was attributed to quality of pain management. Children with persistent pain (those who did not follow the typical trajectory) were likely to be taken to a medical practitioner. One-third of the sample made unscheduled visits to practitioners with most occurring from Day 4 to Day 7 of the follow-up.