title: Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years.
abstract: BACKGROUND
  Surgery of the tonsils often causes severe pain lasting for many days as been shown by data from the National Tonsil Surgery Register in Sweden. Tonsillotomy is associated with fewer readmissions due to bleeding, number of days requiring analgesics and health care contacts due to pain compared to tonsillectomy. The register data demonstrate the necessity of better-evidenced based pain treatment guidelines for tonsil-surgery.
  
  
  OBJECTIVE
  To develop evidenced based pain treatment guidelines for tonsil-surgery in Sweden.
  
  
  METHODS
  The evidence based guidelines were designed by an updated literature review and from the clinical expertise in the pediatric pain field, which thereafter were reviewed by ENT-doctors and anesthetists from each ENT-clinic in Sweden.
  
  
  RESULTS
  A multimodal pain treatment approach is advocated, including premedication and administration during anesthesia, with paracetamol (acetaminophen), clonidine and betamethasone. If not given as a premedication the combination can be administered intravenously in the initial phase of anesthesia. At the end of surgery, if no bleeding problems, cox-inhibitors can be given. After discharge from hospital, the recommendations for pain relief are paracetamol combined with cox-inhibitors (ibuprofen, diclofenac) and if needed oral clonidine in favor of opioids. When pain intensity decreases, discontinue the analgesic treatment in the following order: opioid, clonidine, paracetamol and at last ibuprofen. The need for analgesic treatment after tonsillectomy is usually 5-8 days, after tonsillotomy only 3-5 days. Parents are recommended to contact the hospital if the child has difficulties in drinking or eating adequately and/or suffers from pain despite taking the recommended medication regularly.
  
  
  CONCLUSIONS
  Swedish guidelines for tonsil-surgery provide practical evidence-based pain treatment recommendations.
authors: School of Health and Medical Sciences, Örebro University, Örebro, Sweden. Electronic address: Elisabeth.Ericsson@oru.se.
authors: E
authors: E
authors: Ericsson
authors: Anesthesia and Intensive Care, Sahlgrenska University Hospital, Mölndal, Sweden. Electronic address: Metha.Brattwall@vgregion.se.
authors: M
authors: M
authors: Brattwall
authors: Pain treatment service, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: Stefan.Lundeberg@karolinska.se.
authors: S
authors: S
authors: Lundeberg
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D014066:Palatine Tonsil / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011292:Premedication; D013548:Sweden; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D000700:Analgesics
keywords: Clonidine; Cox-inhibitors; Pain treatment; Paracetamol; Tonsil surgery