title: The use of the FLACC pain scale in pediatric patients undergoing adenotonsillectomy.
abstract: OBJECTIVE
  1) Determine the usage rate of opioid pain medication after adenotonsillectomy (T&A). 2) Review the use of the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale for T&A patients 3) Determine the rate of postoperative physician contacts for pain related complaints.
  
  
  METHODS
  A retrospective case series review was performed on 125 pediatric patients undergoing T&A and subsequent 23-hour postoperative observation at an academic tertiary care center from June-August of 2015. Postoperative pain scores using the FLACC pain scale, the utilization of opioid pain medications, and the number of postoperative contacts for pain were recorded.
  
  
  RESULTS
  Average age of patients was 5.7 years and 50% were female. 90% of T&A's were performed for adenotonsillar hypertrophy. The post-tonsillectomy hemorrhage rate was 4%. 70 (56%) patients required postoperative opioid pain medication, with (30) 43% of these patients requiring more than one dose. The mean number of opioid doses was 1.64 ± 0.9 and was not related to age, weight or gender. FLACC scores were highly associated (spearman correlation 0.77) with the amount of opioid medication given. Mean FLACC scores decreased over time after T&A. 20% of patients contacted a physician for unsatisfactory pain control postoperatively with 6% requiring emergency department visits and 14% contacting the office via phone call.
  
  
  CONCLUSIONS
  A significant portion of pediatric patients undergoing T&A require postoperative opioids for pain control. The FLACC scale is a valuable way of quantifying post-operative T&A pain in pediatric patients. Despite routine pain management postoperatively, a significant proportion of patients require contact with a physician postoperatively for pain management.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, United States. Electronic address: redmanaw@ucmail.uc.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Redmann
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: James
authors.initials: J
authors.lastname: Furstein
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, United States; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Myer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, United States; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Alarcón
mesh_terms: D000233:Adenoidectomy; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D014068:Tonsillectomy
chemical_list: D000701:Analgesics, Opioid
keywords: Adenotonsillectomy; Postoperative pain control; Sleep disordered breathing