Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

Purpose To explore the severity and duration of postoperative pain, the management of analgesics, and postoperative recovery in children undergoing tonsil surgery. Method Participants included 299 children aged 4-17 years undergoing tonsillotomy +/- adenoidectomy (TT +/- A) or tonsillectomy +/- adenoidectomy (TE +/- A). Data were collected up to 12 days. The child rated pain on the Face Pain Scale-Revised (FPS-R) and recovery using the Postoperative Recovery in Children (PRiC) questionnaire. Caregivers assessed their child's pain, anxiety, and nausea on a numeric analog scale and kept a log of analgesic administration. Results High pain levels (FPS-R >= 4) were reported in all surgical and age groups (TT +/- A age 4-11, TE +/- A age 4-11, TE +/- A age 12-17), but there were variations in pain intensity and duration within and between groups. The TE +/- A group scored more days with moderate to very excruciating pain and lower recovery than the TT +/- A group, with the worst outcomes reported by older TE +/- A children. The majority of the children used paracetamol + COX-inhibitors at home, but regular administration of analgesics was lacking, particularly during late evening and at night. Few were received rescue medication (opioid or clonidine) despite severe pain. Physical symptoms and daily life activities were affected during the recovery period. There was moderate agreement between child and the caregiver's pain assessment scores. Conclusion Children reported a troublesome recovery with significant postoperative pain, particularly older children undergoing tonsillectomy. Pain treatment at home was suboptimal and lacked regular analgesic administration. Patient information needs to be improved regarding the importance of regular administration of analgesics and rescue medication.