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1- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
2- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. ,
Abstract:   (52 Views)
Background: Tonsillectomy surgery is a common procedure for alleviating tonsil-related symptoms in children, but effective postoperative pain management remains challenging. Inadequate pain control can result in discomfort, prolonged recovery, and increased complications. This review evaluates pain management methods in tonsillectomy surgery, encompassing preoperative, intraoperative, and postoperative approaches.
Methods: To gather data, a systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted using specific keywords related to tonsillectomy, pain, opioid, recovery, and other relevant factors. Inclusion criteria covered studies published in English between January 2000 and September 2022 involving pediatric and adult tonsillectomy patients. Eligible study types included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses. Studies were initially screened based on titles and abstracts, followed by a full-text review for relevance.
Results: Postoperative pain intensity and prevalence after tonsillectomy can vary significantly. Administering analgesics before pain perception begins, during the surgery-to-awakening period, is critical for optimal pain control. Delayed analgesic administration upon patient awakening may have limited efficacy. Multimodal analgesia, combining different medications with complementary mechanisms of action, is highly effective. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used alongside opioids to achieve synergistic pain relief. Regional anesthesia techniques, like peripheral nerve blocks, provide targeted pain relief and reduce systemic opioid requirements.
Patient education and expectation management are vital for effective pain management. Informing patients and caregivers about the potential severity and duration of postoperative pain, as well as available pain management strategies, reduces anxiety and improves compliance. Psychological factors, including anxiety and fear, influence pain perception and tolerance, necessitating their consideration. Techniques such as cognitive-behavioral therapy, relaxation techniques, and distraction methods improve pain control and reduce anxiety.
Implementation of enhanced recovery after surgery (ERAS) protocols shows promise in optimizing pain management. These protocols involve a multidisciplinary approach, including preoperative optimization, standardized pain management regimens, and early mobilization. By adopting ERAS principles, healthcare providers can enhance postoperative recovery and pain control in tonsillectomy patients.
Conclusion: Effective pain management in tonsillectomy surgery necessitates a multimodal approach with preoperative analgesics, intraoperative techniques like regional anesthesia, and postoperative pain control using a combination of non-opioid and opioid medications. Patient education, addressing psychological factors, and implementing ERAS protocols are critical for optimizing pain management and improving patient outcomes in tonsillectomy surgery

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Type of Study: Narrative Review | Subject: Anesthesiology
Received: 2023/06/10 | Accepted: 2023/11/12

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