title: Confronting the challenges of effective pain management in children following tonsillectomy.
abstract: Tonsillectomy is an extremely common surgical procedure associated with significant morbidity and mortality. The post-operative challenges include: respiratory complications, post-tonsillectomy hemorrhage, nausea, vomiting and significant pain. The present model of care demands that most of these children are managed in an ambulatory setting. The recent Federal Drug Agency (FDA) warning contraindicating the use of codeine after tonsillectomy in children represents a significant change of practice for many pediatric otolaryngological surgeons. This introduces a number of other safety concerns when deciding on a safe alternative to codeine, especially since most tonsillectomy patients are managed by lay primary caregiver's at home. This review outlines the safety issues and proposes, based on currently available evidence, a preventative multi-modal strategy to manage pain, nausea and vomiting without increasing the risk of post-tonsillectomy bleeding.
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Canada. Electronic address: glauder@cw.bc.ca.
authors.forename: Gillian
authors.initials: G
authors.lastname: Lauder
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Emmott
mesh_terms: D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D003061:Codeine; D000075202:Contraindications; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D010597:Pharmacogenetics; D020250:Postoperative Nausea and Vomiting / Q000150:complications; D012131:Respiratory Insufficiency / Q000150:complications; D020181:Sleep Apnea, Obstructive / Q000150:complications; D014068:Tonsillectomy
chemical_list: D000701:Analgesics, Opioid; D003061:Codeine
keywords: Pain management; Pediatric; Tonsillectomy