title: Patterns of pain and analgesic use in 3- to 7-year-old children after tonsillectomy.
abstract: Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. As part of a larger study, 68 children undergoing tonsillectomy were taught to use the Wong-Baker FACES Pain Rating Scale. Pain intensity scores and data about administration of analgesics were collected from children, the medical record, and the parents over a 3-day period. Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home despite significant pain scores of 4 or 5 persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska 68198-5330, USA. mwilson@unmc.edu
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Wilson
authors.forename: Helga L
authors.initials: HL
authors.lastname: Helgadóttir
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods / Q000523:psychology; D000700:Analgesics / Q000627:therapeutic use*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006301:Health Services Needs and Demand; D006701:Home Nursing / Q000193:education / Q000379:methods / Q000523:psychology; D006801:Humans; D007055:Iceland; D008297:Male; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D010290:Parents / Q000193:education / Q000523:psychology*; D010351:Patient Discharge; D011182:Postoperative Care / Q000379:methods / Q000451:nursing / Q000523:psychology; D012720:Severity of Illness Index; D014068:Tonsillectomy / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics