The effect of paracetamol, fentanyl, and systematic assessments on children's pain after tonsillectomy and adenoidectomy.
Various clinical protocols are used to manage early postoperative tonsillectomy and/or adenoidectomy (T&A) pain in children. Although believed to be effective, these protocols are not evidenced-based. Therefore, a double-blind, randomized, placebo controlled (2 x 2) factorial design was used (1) to evaluate the effectiveness of 2 pain protocols used interchangeably to manage early postoperative T&A pain and (2) to investigate whether nurses' systematic pain assessments improve pain management. In the first protocol children receive a loading dose (30 to 50 mg/kg) of paracetamol (acetaminophen) Formularium der Nederlandse Apothekers (Formulary of the Dutch Royal Society for the Advancement of Pharmacy) intraoperatively, followed by regular doses (70 to 100 mg/kg/24 hours) of paracetamol. In the second protocol children receive the first protocol, plus intramuscular fentanyl citrate (1 microgram/kg) intraoperatively. Subjects were 83 healthy children between the ages of 3 and 12 years, admitted for T&A as an outpatient procedure. The child's pain was measured using observation scales (Children's Hospital of Eastern Ontario Pain Scale and Face Legs Activity Cry Consolability Scale), a visual analogue scale, and self-report measures (Faces Pain Scale and Oucher). Neither pain protocol sufficiently relieved early postoperative T&A pain, and systemic pain assessments did not improve the effectiveness of analgesics. Further research evaluating the effectiveness of pain management protocols is needed.
Hamers
J P
JP
Department of Nursing Science, Maastricht University, The Netherlands.
Huijer Abu-Saad
H
H
Geisler
F E
FE
van den Hout
M A
MA
Schouten
H J
HJ
Halfens
R J
RJ
van Suijlekom
H A
HA
D000082:Acetaminophen / Q000627:therapeutic use*; D000233:Adenoidectomy / Q000009:adverse effects*; D000556:Ambulatory Surgical Procedures / Q000451:nursing; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology / Q000451:nursing*; D019990:Perioperative Care / Q000379:methods / Q000451:nursing; D014068:Tonsillectomy / Q000009:adverse effects*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D005283:Fentanyl