How to Manage Tonsillectomy Pain in Children?

New physician anesthesiologist-led protocol for tonsillectomy pain control reduces variability, improves patient care, and plays an important role in pain control.

Providing children oral instead of intravenous (IV) acetaminophen to help manage tonsillectomy pain improves care at lower costs, according to research being presented at the Anaesthesiology 2021 annual meeting.

“Tonsillectomy is one of the most painful surgeries,” said Melissa Brooks Peterson, M.D., lead author of the study and associate professor of anesthesiology at Children’s Hospital Colorado and the University of Colorado School of Medicine, Aurora.

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‘Providing oral rather than IV acetaminophen to children having tonsillectomies improves care and saves costs.’

Tonsillectomy, the removal of the tonsils sometimes along with the adenoids is one of the most common procedures in children, with more than 500,000 performed each year.

Children may have tonsillectomies due to recurrent infections of the tonsils or because they are experiencing abnormal breathing patterns while sleeping, which in some cases can be dangerous.

Acetaminophen is the first step in pain management for tonsillectomies with or without adenoidectomy. Some children were given oral acetaminophen before the procedure and others received it via IV during the procedure.

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With reports of codeine-related fatalities on a rise, choice of post-tonsillectomy analgesia could be quite challenging.

Physician anesthesiologists at Children’s Hospital Colorado employed a multimodal approach to pain management in tonsillectomy meaning they use a variety of medications throughout the process to treat pain in multiple ways, thereby reducing the need for opioids after surgery.

In addition to the acetaminophen before surgery, the multimodal approach includes giving children a high-dose steroid and an opioid medication during surgery.

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After the procedure, they receive a dose of a non-steroidal anti-inflammatory drug (NSAID) usually ibuprofen. In the hospital and once home, children receive alternating doses of an NSAID and acetaminophen, which usually provides effective pain management. Children are given opioids only if they have breakthrough pain.

The researchers also surveyed nurses and another staff before and after the protocol was enacted. Staff reported they were much more satisfied with the new protocol, including the care given to the children and their role in providing it.

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A new study has found that the risk of complications following tonsillectomy is higher among children who come from lower income families.

“Nurses find managing kids in the recovery room after tonsillectomies can be challenging because the children go into the procedure fine and can come out of surgery in extreme pain”, said Dr. Brooks Peterson.

Additionally, switching from IV to oral acetaminophen saves more cost. The new process standardizes care, which also can help to reduce medical errors.

Source-Medindia