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. 2020 Mar 6;5(2):e819.
doi: 10.1097/PR9.0000000000000819. eCollection 2020 Mar-Apr.

A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials

Andrea C Postier  1 , Christine Chambers  2   3   4 , David Watson  5 , Craig Schulz  6 , Stefan J Friedrichsdorf  1   7   8
Affiliations

A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials

Andrea C Postier et al. Pain Rep. .

Abstract

Pediatric tonsillectomy involves an often painful and lengthy recovery period, yet the extended recovery process is largely unknown. This article describes postoperative recovery outcomes for 121 children aged 4 to 15 (mean 6.6 years, SD = 2.3) years enrolled in 1 of 2 clinical trials of analgesia safety and efficacy after tonsillectomy. Postoperative analgesia included scheduled opioid analgesic plus acetaminophen/ibuprofen medication use (first 5 days) and "as-needed" use (last 5 days). Clinical recovery as measured daily by the Parents' Postoperative Pain Measure (PPPM; an observational/behavioral pain measure), children's self-reported pain scores, side-effect assessments, need for unanticipated medical care, and satisfaction with recovery over 10 days was assessed. Higher Parents' Postoperative Pain Measure scores were correlated with poorer sleep, receipt of breakthrough analgesics, distressing side effects, higher self-reported pain scores, and need for unanticipated medical care. Higher self-reported pain scores were associated with more distressing adverse events, including nausea, vomiting, insomnia, lower parent satisfaction, and unplanned medical visits and hospitalizations. Pain and symptoms improved over time, although 24% of the children were still experiencing clinically significant pain on day 10. Scheduled, multimodal analgesia and discharge education that sets realistic expectations is important. This study adds to the emerging body of literature that some children experience significant postoperative pain for an extended period after tonsillectomy.

Keywords: Acute pain; Breakthrough pain; Pain assessment; Pain management; Pediatrics; Tonsillectomy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
A CONSORT flow diagram.
Figure 2.
Figure 2.
A comparison of daily pain scores during a 10-day post-tonsillectomy follow-up period for children as assessed with the PPPM and FACES Pain Scale-Revised or NRS-11: worst, average, and current (time of survey). PPPM, Parents' Postoperative Pain Measure.
Figure 3.
Figure 3.
Daily percentage of children experiencing side effects during the 10-day postoperative recovery period.
See this image and copyright information in PMC

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