Pain management after tonsillectomy: morphine is not enough.
BACKGROUND
Tonsillectomy is usually done as day surgery, transferring to the parents most of the postoperative care. They often feel alone and incompetent in front of a child in pain. We developed a guide to help parents for both the evaluation and the management of postoperative pain.


OBJECTIVE
To improve pediatric posttonsillectomy pain management with the implementation of a parental guide and treatment algorithm.


METHODS
Eighty children (5-17 years) were recruited in this randomized clinical trial. Parents and children were assigned to one of the research groups: control or experimental. All received an identical prescription for acetaminophen (15 mg/kg) and morphine (0.3 mg/kg), information about the medication, a visual analogue scale (VAS), and index cards to be filled at home. The experimental group also received a treatment algorithm associating pain scores with analgesics.


RESULTS
Pain scores for the control group and the experimental group were 5.3 and 4.7 on the day of surgery, 4.0 and 3.6 the next day, 2.2 and 2.3 3 days later, and 1.6 and 1.4 1 week after the intervention, respectively. The side effects and the analgesics given were comparable for both groups.


CONCLUSIONS
No significant difference was demonstrated for the studied parameters, probably because the majority of the parents followed the prescriptions well. The guide was much appreciated. The children understood the VAS easily and liked using it. The combination of acetaminophen-morphine needs to be revisited since pain remains problematic.
Vallée
Estelle
E
Department of Pediatrics, University of Sherbrooke, Sherbrooke, QC, Canada.
Lafrenaye
Sylvie
S
Tétrault
Jean-Pierre
JP
Mayer
Sandeep
S
Dorion
Dominique
D
D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000465:Algorithms; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010290:Parents / Q000193:education; D014068:Tonsillectomy
D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine