Ericsson E, Brattwall M, Lundeberg S
School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Anesthesia and Intensive Care, Sahlgrenska University Hospital, Mölndal, Sweden.
Int J Pediatr Otorhinolaryngol. 2015 Apr;79(4):443-50. doi: 10.1016/j.ijporl.2015.01.016. Epub 2015 Jan 24.
Surgery of the tonsils often causes severe pain lasting for many days as been shown by data from the National Tonsil Surgery Register in Sweden. Tonsillotomy is associated with fewer readmissions due to bleeding, number of days requiring analgesics and health care contacts due to pain compared to tonsillectomy. The register data demonstrate the necessity of better-evidenced based pain treatment guidelines for tonsil-surgery.
To develop evidenced based pain treatment guidelines for tonsil-surgery in Sweden.
The evidence based guidelines were designed by an updated literature review and from the clinical expertise in the pediatric pain field, which thereafter were reviewed by ENT-doctors and anesthetists from each ENT-clinic in Sweden.
A multimodal pain treatment approach is advocated, including premedication and administration during anesthesia, with paracetamol (acetaminophen), clonidine and betamethasone. If not given as a premedication the combination can be administered intravenously in the initial phase of anesthesia. At the end of surgery, if no bleeding problems, cox-inhibitors can be given. After discharge from hospital, the recommendations for pain relief are paracetamol combined with cox-inhibitors (ibuprofen, diclofenac) and if needed oral clonidine in favor of opioids. When pain intensity decreases, discontinue the analgesic treatment in the following order: opioid, clonidine, paracetamol and at last ibuprofen. The need for analgesic treatment after tonsillectomy is usually 5-8 days, after tonsillotomy only 3-5 days. Parents are recommended to contact the hospital if the child has difficulties in drinking or eating adequately and/or suffers from pain despite taking the recommended medication regularly.
Swedish guidelines for tonsil-surgery provide practical evidence-based pain treatment recommendations.
瑞典国家扁桃体手术登记处的数据显示，扁桃体手术常常会导致持续多日的剧痛。与扁桃体切除术相比，扁桃体切开术因出血导致的再入院次数、因疼痛所需的镇痛药使用天数以及医疗保健接触次数更少。登记处数据表明，有必要制定更有循证依据的扁桃体手术疼痛治疗指南。
制定瑞典扁桃体手术的循证疼痛治疗指南。
循证指南通过更新文献综述并结合儿科疼痛领域的临床专业知识来设计，之后由瑞典各耳鼻喉科诊所的耳鼻喉科医生和麻醉师进行审核。
提倡采用多模式疼痛治疗方法，包括麻醉前用药及麻醉期间用药，使用对乙酰氨基酚、可乐定和倍他米松。如果未作为麻醉前用药给予，该组合可在麻醉初始阶段静脉给药。手术结束时，若没有出血问题，可给予环氧化酶抑制剂。出院后，止痛建议为对乙酰氨基酚联合环氧化酶抑制剂（布洛芬、双氯芬酸），必要时口服可乐定，而非使用阿片类药物。当疼痛强度降低时，按以下顺序停用镇痛治疗：阿片类药物、可乐定、对乙酰氨基酚，最后是布洛芬。扁桃体切除术后镇痛治疗通常需要5 - 8天，扁桃体切开术后仅需3 - 5天。建议家长，如果孩子在正常饮食方面有困难和/或尽管定期服用推荐药物仍遭受疼痛，应联系医院。
瑞典扁桃体手术指南提供了实用的循证疼痛治疗建议。
