The effect of paracetamol, fentanyl, and systematic assessments on children's pain after tonsillectomy and adenoidectomy

• Published in: Journal of perianesthesia nursing Vol. 14; no. 6; pp. 357 - 366
• Main Authors: Hamers, Jan P.H., Abu-Saad, Huda Huijer, Geisler, Ferd E.A., van den Hout, Marcel A., Schouten, Hubert J.A., Halfens, Ruud J.G., van Suijlekom, Hans A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.1999
• Subjects: Acetaminophen - therapeutic use; Adenoidectomy - adverse effects; Ambulatory Surgical Procedures - nursing; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Child; Child, Preschool; Double-Blind Method; Female; Fentanyl - therapeutic use; Humans; Male; Nursing; Nursing Assessment - methods; Pain Measurement - methods; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pain, Postoperative - nursing; Perioperative Care - methods; Perioperative Care - nursing; Tonsillectomy - adverse effects
• ISSN: 1089-9472; 1532-8473
• DOI: 10.1016/S1089-9472(99)80097-5

Various clinical protocols are used to manage early postoperative tonsillectomyand/or adenoidectomy (T&A) pain in children. Although believed to be effective, these protocols are not evidenced-based. Therefore, a double-blind, randomized, placebo controlled (2×2) factorial design was used (1) to evaluate the effectiveness of 2 pain protocols used interchangeably to manage early postoperative T&A pain and (2) to investigate whether nurses' systematic pain assessments improve pain management. In the first protocol children receive a loading dose (30 to 50 mg/kg) of paracetamol (acetaminophen) Formularium der Nederlandse Apothekers (Formulary of the Dutch Royal Society for the Advancement of Pharmacy) intraoperatively, followed by regular doses (70 to 100 mg/kg/24 hours) of paracetamol. In the second protocol children receive the first protocol, plus intramuscular fentanyl citrate (1 μg/kg) intraoperatively. Subjects were 83 healthy children between the ages of 3 and 12 years, admitted for T&A as an outpatient procedure. The child's pain was measured using observation scales (Children's Hospital of Eastern Ontario Pain Scale and Face Legs Activity Cry Consolability Scale), a visual analogue scale, and self-report measures (Faces Pain Scale and Oucher). Neither pain protocol sufficiently relieved early postoperative T&A pain, and systemic pain assessments did not improve the effectiveness of analgesics. Further research evaluating the effectiveness of pain management protocols is needed.