Posttonsillectomy Pain in Children: Safer, More Effective Treatment Strategies

By Shawn Kennedy, editor-in-chief


One of the CE articles in the February issue is “Posttonsillectomy Pain in Children.” It might seem like a no-brainer—ice-collar, cold fluids, and acetaminophen with codeine, right? WRONG. As the article indicates, there’s a lot more to managing this stubborn, sometimes severe pain.

For one thing, there’s been a big reversal in choice of pain medication. Acetaminophen with codeine, long a mainstay in managing children’s pain, is no longer recommended—in fact, the FDA issued a black box warning last year saying that codeine should not be used because its metabolism rate in one subset of children can cause excessive sedation. Reports of three deaths and a case of nonfatal respiratory depression in children who received appropriate doses prompted the warning.

So what can you use? According to the article, by pediatric pain CNS Kimberly Sutter and pediatric otolaryngology surgeon Glenn Isaacson, “hydrocodone in combination with acetaminophen (Vicodin and others) has been advocated as an effective alternative opioid for managing pediatric posttonsillectomy pain.”

But a number of other factors go into a plan for pain management, and this article covers the gamut. Here’s the abstract:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

It’s worth a read—and you can earn 2.3 contact hours.

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Editor-in-chief, AJN

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