Richards Julianne, Lang Mary, Andresen Elizabeth, O'Leary Kathryn, Jauncey-Cooke Jacqueline, Anderson Nicole, Burns Hannah, Slee Nicola, Ullman Amanda J, Cooke Marie
Queensland Children's Hospital, Children's Health Queensland, Hospital and Health Service, Brisbane, Queensland, Australia.
School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2020 Jan;56(1):114-122. doi: 10.1111/jpc.14505. Epub 2019 May 29.
Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery.
A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7-14 days post-surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016.
The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy (n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea (n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra-operative pain relief and antiemetics was administered. Pain was present in 29% (n = 26) of participants at ward return, increasing to 32-45% at 4-20 h and decreasing to 21% (n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post-discharge interview, and 30% (n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post-operatively, and 31% (n = 39) had finished their oxycodone. Of the participants, 14% (n = 26) presented to the emergency department within 7 days of discharge; 8% (n = 20) of the total cohort were re-admitted.
There was variety in perioperative and post-discharge care. Pain scores were infrequently documented post-tonsillectomy, and parents are generally dissatisfied with the management of post-operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery.
扁桃体切除术是儿科的一项核心手术；然而，围手术期管理存在差异。本研究旨在描述扁桃体切除术的管理情况，包括疼痛负担、恶心和恢复延迟情况。
通过对扁桃体切除围手术期实践和恢复情况进行审计，并在术后7 - 14天对家庭成员进行调查访谈，开展了一项前瞻性队列研究。该研究于2016年6月至9月在一家澳大利亚三级转诊儿科医院进行。
审计纳入了255例接受扁桃体切除术的儿童，对127名家庭成员进行了访谈。大多数参与者接受了腺扁桃体切除术（n = 216；85%），主要诊断为阻塞性睡眠呼吸暂停（n = 205；80%），平均年龄7岁（标准差；3.9）。术中使用了多种止痛和止吐药物。返回病房时，29%（n = 26）的参与者存在疼痛，4 - 20小时时疼痛发生率增至32% - 45%，出院时降至21%（n = 15）。三分之一的儿童（32%；n = 41）在出院后访谈时存在中度至重度疼痛，30%（n = 38）在家中经历过恶心。大多数家长（82%；n = 104）在术后7天仍在定期给孩子服用对乙酰氨基酚，31%（n = 39）已停用羟考酮。在参与者中，14%（n = 26）在出院后7天内前往急诊科就诊；整个队列中有8%（n = 20）再次入院。
围手术期和出院后护理存在差异。扁桃体切除术后疼痛评分记录较少，家长对术后疼痛和恶心的管理普遍不满意。需要进一步研究以提供更一致的围手术期管理方法来促进恢复。
