The importance of including parents in the successful management of pain is highlighted in the AAO-HNS guidelines, in which a number of recommendations are provided to caregivers on helping to manage pain in their children (see “Parent Education: Post-Tonsillectomy Pain Management Guidelines for Caregivers,” p. 26).
Explore this issue:September 2012
Dr. Tunkel emphasized that parents often do not provide adequate pain medication to their children despite rating their children’s pain as very high, furthering the need for clear communication from otolaryngologists and other physicians regarding the importance of compliance with the prescribed pain medications.
The Bottom Line
Adequate pain control in children after tonsillectomy is critical to ensure proper hydration and a return to normal eating after surgery. The once well-established use of acetaminophen and codeine has come under scrutiny following an increasing number of codeine-related fatalities in young children undergoing tonsillectomy. Until a good way to screen children who are at risk of opioid-related complications is available, many physicians recommend against the use of narcotics in young children—particularly those undergoing tonsillectomy for sleep apnea.
Alternative strategies using around-the-clock dosing of acetaminophen and ibuprofen have shown good results without the risks of opioids or increased bleeding risk with ibuprofen. Although this approach to pain management is not yet an established evidence-based strategy, it has received endorsement by the AAO-HNS as a viable option. Along with choosing the safest and most effective pain analgesic, compliance with safe pain medications is also critical, and parents must be educated on the importance of adequate pain control for their children.