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Pain Management After a Tonsillectomy

written by: AngelicaMD • edited by: dianahardin • updated: 5/24/2011

Inadequate pain management after tonsil surgery can lead to problems or complications, such as nausea, vomiting, poor hydration, sleep disturbance and behavioral changes, especially in children. Learn how to relieve pain after tonsillectomy and avoid these undesired situations.

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    What Happens During and After Tonsillectomy?

    Tonsillectomy is a surgical procedure often performed in children, and less commonly in adults, who have a history of recurrent bacterial tonsillitis not relieved by medical treatment. It is also done when the tonsils cause snoring, breathing and swallowing problems, when they are enlarged and non-responsive to medical intervention.

    The surgery is done under general anesthesia, but local and intravenous analgesia and anesthesia may also be given. In very young children a rectal suppository of acetaminophen may be part of the pre-operative medication.

    Post-operatively, tonsillectomy patients are observed in the recovery room, where pain management continues. Tonsillectomy causes severe sore throat in some and can lead to difficulty in swallowing; hence, pain medications are given immediately after the operation and usually consist of acetaminophen, given as a suppository or as an oral medication. Some physicians prescribe acetaminophen with codeine for greater pain relief. After a day or so, the patients may be sent home with a prescription for pain medication, which may not be administered properly by parents. Frequently, children are not given enough medication to relieve the pain.

    A study in the Journal of Pediatric Nursing revealed that inadequate pain relief after tonsillectomy may be related to other complications in children. Because of intense pain, children sometimes experience confusion, which manifests as excessive crying and altered behavior. They may also experience vomiting, slight bleeding and difficulty in swallowing. Feeding and hydration can be a problem. Sleeping may also be disturbed, and a few parents may be anxious enough to bring them back to the clinic for consultation.

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    Pain Relief After Tonsillectomy

    Patients usually experience inadequate relief from pain after surgery because of inadequate dosage, or when medications are not given at the right time intervals. Ideally, analgesics or pain relievers are given at a dose computed according to the patient’s body weight, as in milligrams per kilogram of body weight. They should not exceed the doses recommended.

    The frequency and timing of drug intake should also be followed, and for pain to be adequately covered, medications are usually given regularly, on an around-the-clock basis in the first few days, later shifting to a per-need basis. Thus, if a drug were meant to be taken every 8 hours (or thrice a day), skipping or delaying a dose may result in pain.

    Plain acetaminophen syrup or suppositories are usually given to children under 6 years of age. Aspirin is not recommended, because it may cause bleeding and, in rare cases, lead to a condition called Reye’s syndrome, where the kidneys are adversely affected, causing death.

    For older children and adults, acetaminophen with codeine may be prescribed. Doses and frequency are usually recommended by the physician, or calculated according to the weight and age of the patient. Some non-steroidal analgesic drugs, like ibuprofen, may be prescribed by doctors, but others stay away from them because of the possible complications, like bleeding and stomach irritation. These medications may be bought over the counter, and packaging usually includes recommended doses.

    When pain and difficulty in swallowing have diminished to a more tolerable level, analgesics may be given on a per-need basis, rather than around-the-clock.

    Other symptoms, like vomiting and irritability may be relieved as a consequence of adequate pain relief. To avoid eating discomfort or children refusing to eat or drink, cold liquids and soft foods, like ice cream, may be started. Recommended foods after tonsillectomy are usually provided by the physician. Avoiding sour juices, like citrus drinks, and crunchy or hard foods also helps decrease pain with swallowing. If symptoms persist for more than 24 hours, medical consultation should be sought.

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    References

    Journal of Pediatric Nursing, “Inadequate pain management and associated morbidity in children at home after tonsillectomy,” http://www.ncbi.nlm.nih.gov/pubmed/9198341.

    American Academy of Otolaryngology. “Tonsillectomy Pain Management,” http://www.entnet.org/AboutUs/Q-A-TAPainManagement.cfm.

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    Sample contents.