Impact of a revised postoperative care plan on pain and recovery trajectory following paediatric tonsillectomy.

BACKGROUND A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate-severe post-tonsillectomy pain scores lasting a median (range) duration of 6 (0-23) days and post-discharge nausea and vomiting affecting 8% of children on day one following surgery. In this subsequent cohort we evaluate changes to our discharge medication and parental education aimed at improving these outcomes. AIMS To evaluate the impact of a modified analgesic regimen and increased parental education on post-tonsillectomy pain and recovery profile. METHODS In this follow on, prospective observational cohort study, all patients undergoing tonsillectomy at our institution during the study period were discharged with standardised analgesia. Parents received a revised education package and a medication diary which were not provided to the previous cohort. Pain scores, rates of nausea and vomiting, and medication usage and unplanned representation rates were collected by telephone from parents. RESULTS Sixty-nine patients were recruited. Moderate-severe pain lasted a median (range) of 5 (0-12) days. Twenty-nine (42%) had pain scores ≥4/10 beyond Post-Operative Day (POD) 7. By POD 5, only 37 (53%) parents continued to administer regular analgesia. The median number of oxycodone doses used was 5 (0-22) and only 28 (41%) parents had disposed of leftover oxycodone within one month of surgery. Twenty-four (35%) patients experienced nausea or vomiting post discharge. The median (range) time for return to normal activities was 6 (0-14) days. Thirty-two/sixty-nine (46%) patients had unplanned medical representations. Most occurred between POD 5-7. Pain contributed in 16 (35%) representations. CONCLUSIONS Despite extensive changes to our discharge protocols parents continued to report a prolonged period of pain, PONV and behavioural changes. Further work is required to examine barriers to compliance with simple analgesia and education in appropriate methods of opioid disposal.