Beth Andresen1, Mary Lang1, Amanda Ullman1, Jacqueline Jauncey-Cooke1, Marie Cooke1
Background & Aim: The aim was to describe local tonsillectomy management with a focus on pain management to inform knowledge translation and future research projects.
Methods: We undertook a prospective audit (June-Sept 2016) of current tonsillectomy clinical practice, post-operative pain, nausea and vomiting in paediatrics.
Results: Participants were predominantly undergoing adenotonsillectomy (84%; n=216) due to obstructive sleep apnoea (n=213; 83%), with a median age of 6 years (IQR 4, 9). The majority underwent a gas induction (82%) and received a variety of intra-operative opioids (Fentanyl 85.6%, n=220; Morphine 44.8%; n=115), anti-inflammatories (Paracoxib 58%; n=151); other pain relief (IV paracetamol 85%, n=220; IV clonidine 53%; n=137); and anti-emetics (Ondansetron 89%, n=229; Dexamethasone 95.7%, n=246). Documented median pain (11-point numeric rating scale) in post-anaesthetic period decreased from 3/10 (IQR 1, 6), to 1/10 at return to ward (IQR 1,4); but increased to 3/10 at the 16 and 20 hours post-anaesthetic period (IQR 1,4). Pain scores were poorly documented with 33 children (13%) without a documented pain score in the ward. Paracetamol and Oxycodone were the mainstay with only 41% (n=106) receiving ibuprofen during this phase. Rescue anti-emetics were required in a quarter of the patients (Ondansetron n=56; Metoclopramide n=7; Dexamethasone n=4) postoperatively.
Almost a third of participants (29%; n=82) presented to emergency after discharge, primarily due to haemorrhage (n= 43; 52%), pain (n=29, 35%) and dehydration (n=20; 24%), with 17% of the total cohort being re-admitted.
Conclusions: The results indicate substantial variety exists in analgesic management with a more consistent approach to nausea and vomiting for children undergoing tonsillectomy in one institution. The range of analgesia and anti-inflammatories administered appears to manage pain in most cases during post-operative stay. The low documentation rate of pain scores in the ward is a limitation in this study.
Acknowledgements/Disclosures: Children’s Hospital Foundation Innovation Grant 10418-2.