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Pain after tonsillectomy: effectiveness of current guidelines?

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Abstract

Background

Tonsillectomy is one of the most common major surgical procedures performed in children. In 2013, the use of codeine in children was severely restricted. French guidelines for treating tonsillectomy’s postoperative pain at home have been reconsidered

Objective

The aim of our study was to measure effectiveness and safety of two schedules: acetaminophen + ibuprofen (A + I) and acetaminophen + tramadol (A + T) in children who underwent tonsillectomy.

Setting and patients

We undertook a 1 year prospective and observational single-center study. All children who underwent tonsillectomy were eligible. The choice of the regimen, A + I group or A + T group, was left for the anesthesiologist in charge, done during the pre-anesthetic assessment. After hospital discharge, parents had to give systematically A + I or A + T, 4 times a day during 5 days and then acetaminophen alone for the next 5 days The primary endpoint was the home pain assessed using Parents’ Postoperative Pain Measurement Short Form (PPPM-SF) scale. Secondary endpoints were the rate of further hospitalization and/or surgery due to tonsillectomy-related adverse events.

Results

Over the study period, 342 tonsillectomies were performed. The return rate of PPPM-SF scales was 58%. Two hundred patients were analyzed. The median age was 4 [3; 5.2] years and was lower in group A + I (4 [3; 5]; 5 [4; 7]; p < 0.0001). PPPM-SF scores were greater than or equal to 3 in both groups during the first 6 postoperative days. The mean decrease of PPPM-SF score over time was higher in group A + I than in group A + T (p = 0.007). Readmission rate was significantly higher in group A + T (A + I: 0; A + T: 7; p = 0.002) as the rate of reoperation for bleeding (A + I: 0; A + T: 3; p = 0.049).

Conclusion

Home pain management after tonsillectomy should be improved. In clinical practice, A + I seems at least as effective as the combination A + T, without increasing readmission and/or additional surgery for bleeding.

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Authors and Affiliations

  1. Department of Anesthesiology, Fondation Lenval, Nice, France

    Y. Walrave, C. Hayem & F. De la Brière

  2. Department of Otorhinolaryngology, Fondation Lenval, Nice, France

    C. Maschi & S. Bailleux

  3. Department of Radiation Oncology, Antoine Lacassagne Center, Nice, France

    A. T. Falk

  4. Department of Anesthesiology and Intensive Care, CHRU, Pointe-à-Pitre, Guadeloupe, France

    M. Carles

Authors
  1. Y. Walrave
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  2. C. Maschi
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  3. S. Bailleux
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  4. A. T. Falk
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  5. C. Hayem
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  6. M. Carles
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  7. F. De la Brière
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Corresponding author

Correspondence to Y. Walrave.

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Funding

This study was not funded.

Conflict of interest

Y. Walrave declares that he has no conflict of interest. C. Maschi declares that he has no conflict of interest. M. Carles is a member of Societé Française d’Anesthésie Réanimation (SFAR). AT. Falk declares that he has no conflict of interest. S. Bailleux declares that he has no conflict of interest. C. Hayem declares that he has no conflict of interest. F. De la Brière declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Walrave, Y., Maschi, C., Bailleux, S. et al. Pain after tonsillectomy: effectiveness of current guidelines?. Eur Arch Otorhinolaryngol 275, 281–286 (2018). https://doi.org/10.1007/s00405-017-4788-0

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  • DOI: https://doi.org/10.1007/s00405-017-4788-0

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