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Impact of paediatric tonsillectomy perioperative management on pain, nausea and recovery: A prospective cohort study
Author(s) -
Richards Julianne,
Lang Mary,
Andresen Elizabeth,
O'Leary Kathryn,
JaunceyCooke Jacqueline,
Anderson Nicole,
Burns Hannah,
Slee Nicola,
Ullman Amanda J,
Cooke Marie
Publication year - 2020
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.14505
Subject(s) - medicine , tonsillectomy , nausea , perioperative , prospective cohort study , cohort , cohort study , pediatrics , anesthesia , emergency medicine , physical therapy , surgery
Aim Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery. Methods A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7–14 days post‐surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016. Results The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy ( n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea ( n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra‐operative pain relief and antiemetics was administered. Pain was present in 29% ( n = 26) of participants at ward return, increasing to 32–45% at 4–20 h and decreasing to 21% ( n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post‐discharge interview, and 30% ( n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post‐operatively, and 31% ( n = 39) had finished their oxycodone. Of the participants, 14% ( n = 26) presented to the emergency department within 7 days of discharge; 8% ( n = 20) of the total cohort were re‐admitted. Conclusions There was variety in perioperative and post‐discharge care. Pain scores were infrequently documented post‐tonsillectomy, and parents are generally dissatisfied with the management of post‐operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery.