Pre-surgical child behavior ratings and pain management after two different techniques of tonsil surgery.
OBJECTIVE
The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain.


METHODS
Ninety-two children (5-15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE).


METHODS
Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac.


RESULTS
These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated.


CONCLUSIONS
SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.
Ericsson
Elisabeth
E
Division of Otorhinolaryngology, Department of Neuroscience and Locomotion (INR), Faculty of Health Sciences, University of Linköping, SE-581 85 Linköping, Sweden. elier@inr.liu.se
Wadsby
Marie
M
Hultcrantz
Elisabeth
E
D000082:Acetaminophen / Q000008:administration & dosage; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000758:Anesthesia; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001007:Anxiety / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D004008:Diclofenac / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D012044:Regression Analysis; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000523:psychology*; D014069:Tonsillitis / Q000601:surgery
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D000082:Acetaminophen; D009020:Morphine