Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.
Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia.
Paediatr Anaesth. 2021 Jul;31(7):778-786. doi: 10.1111/pan.14187. Epub 2021 Apr 18.
A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate-severe post-tonsillectomy pain scores lasting a median (range) duration of 6 (0-23) days and postdischarge nausea and vomiting affecting 8% of children on day 1 following surgery. In this subsequent cohort, we evaluate the impact of changes to our discharge medication and parental education on post-tonsillectomy pain and recovery profile.
In this follow-on, prospective observational cohort study, all patients undergoing tonsillectomy at our institution during the study period were discharged with standardized analgesia. Parents received a revised education package and a medication diary which were not provided to the previous cohort. Pain scores, rates of nausea and vomiting, medication usage and unplanned representation rates were collected by telephone from parents.
Sixty-nine patients were recruited. Moderate-severe pain lasted a median (range) of 5 (0-12) days. Twenty-nine (42%) had pain scores ≥4/10 beyond postoperative day 7. By postoperative day 5, only 37 (53%) parents continued to administer regular analgesia. The median number of oxycodone doses used was 5 (0-22), and only 28 (41%) parents had disposed of leftover oxycodone within 1 month of surgery. Twenty-four (35%) patients experienced nausea or vomiting postdischarge. The median (range) time for return to normal activities was 6 (0-14) days. Thirty-two/sixty-nine (46%) patients had unplanned medical representations. Most occurred between postoperative day 5 and 7. Pain contributed to 16 (35%) representations.
Despite extensive changes to our discharge protocols parents continued to report a prolonged period of pain, post operative nausea and vomiting, and behavioral changes. Further work is required to examine barriers to compliance with simple analgesia and education in appropriate methods of opioid disposal.
我们机构之前的一组腺样体切除术患者表现出中度至重度扁桃体切除术后疼痛评分，持续中位数（范围）6 天（0-23 天），术后出院第一天 8%的儿童出现恶心和呕吐。在这个后续队列中，我们评估了我们出院药物和家长教育的变化对扁桃体切除术后疼痛和恢复情况的影响。
在这项后续前瞻性观察队列研究中，我们机构在研究期间接受扁桃体切除术的所有患者均接受标准化镇痛出院。家长收到了修订后的教育包和用药日记，而前一组患者没有收到。通过电话从家长那里收集疼痛评分、恶心和呕吐发生率、药物使用情况和计划外就诊率。
共招募 69 名患者。中度至重度疼痛持续中位数（范围）为 5 天（0-12 天）。29 名（42%）患者术后第 7 天疼痛评分≥4/10。术后第 5 天，只有 37 名（53%）家长继续常规给予镇痛剂。使用羟考酮的中位数剂量为 5（0-22），只有 28 名（41%）家长在术后 1 个月内处理了剩余的羟考酮。24 名（35%）患者出院后出现恶心或呕吐。恢复正常活动的中位数（范围）时间为 6 天（0-14 天）。32/69（46%）名患者计划外就诊。大多数发生在术后第 5 天至第 7 天。疼痛导致 16 次（35%）就诊。
尽管我们的出院方案发生了广泛的变化，但家长仍继续报告疼痛持续时间长、术后恶心和呕吐以及行为改变。需要进一步研究以检查遵守简单镇痛和教育的适当阿片类药物处理方法的障碍。
