title: Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children.
abstract: BACKGROUND
  Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting.
  
  
  METHODS
  A prospective cohort study was performed including 167 children aged 0-12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre- and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around-the-clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability-scale (FLACC), as well as during a 1-week follow-up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores.
  
  
  RESULTS
  All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively.
  
  
  CONCLUSIONS
  Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.
authors.affiliation: Department of Anesthesia, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Kristy M J
authors.initials: KM
authors.lastname: Vons
authors.forename: Jilles B
authors.initials: JB
authors.lastname: Bijker
authors.forename: Edwin W
authors.initials: EW
authors.lastname: Verwijs
authors.forename: Maarten H J M
authors.initials: MH
authors.lastname: Majoor
authors.forename: Jurgen C
authors.initials: JC
authors.lastname: de Graaff
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D017409:Sufentanil / Q000627:therapeutic use; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D000082:Acetaminophen; D017409:Sufentanil
keywords: adenotonsillectomy; ambulatory; children; pediatric anesthesia; postoperative pain; surgical procedure; tonsillectomy