A descriptive feasibility study to evaluate scheduled oral analgesic dosing at home for the management of postoperative pain in preschool children following tonsillectomy.
OBJECTIVE
The purpose of this study, in a sample of preschool children (ages 3-5 years; N = 47), was to evaluate the feasibility of scheduled analgesic dosing following outpatient tonsillectomy in order to optimize pain management.


METHODS
Parents were instructed to give their child acetaminophen with hydrocodone (167 mg/5 mL) every 4 hours around the clock for the first 3 days following surgery. Parents recorded ratings of their child's pain with/without swallowing using the Faces, Legs, Activity, Cry, and Consolability (FLACC) behavioral pain scale, pain relief ratings, and severity of analgesic side effects in a home diary. Audiotaped interviews were conducted with parents to document descriptions of their experiences in managing their child's pain at home.


RESULTS
Mean FLACC scores with/without swallowing were less than two at each measurement time and pain relief scores increased over time. Total analgesic dose decreased, and the number of missed doses increased over the first 3 days after surgery. Moderate-to-severe daytime sedation, nausea, vomiting, and constipation were reported by parents.


CONCLUSIONS
Study results suggest that acetaminophen with hydrocodone is effective in relieving preschool children's pain following tonsillectomy and that parental adherence to a scheduled analgesic regimen decreases over time. Time-contingent dosing was associated with moderate to severe side effects and should be addressed in discharge teaching with parents. Findings provide insight into parents' perspective of pain management at home following tonsillectomy and methods for relieving their child's pain.
Surgical Services, Pain Management, Children's Hospital Central California, Madera, California 93636-8761, USA. ksutters@childrenscentralcal.org
Kimberly A
KA
Sutters
Danielle
D
Holdridge-Zeuner
Steven
S
Waite
Steven M
SM
Paul
Marilyn C
MC
Savedra
Brent
B
Lanier
Karla
K
Mahoney
Christine
C
Miaskowski
D000082:Acetaminophen / Q000008:administration & dosage; D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D017028:Caregivers; D002675:Child, Preschool; D004338:Drug Combinations; D005240:Feasibility Studies; D006699:Home Care Services; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing; D010290:Parents; D014068:Tonsillectomy / Q000009:adverse effects; D016903:Drug Monitoring
D000701:Analgesics, Opioid; D004338:Drug Combinations; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone