Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Several researchers have found inadequate pain management in children at home after tonsillectomy in a day surgery setting. The purpose of this study was to describe the patterns of pain intensity and analgesic administration in 3-7 year old children undergoing tonsillectomy during the operative day in the hospital and the first two postoperative days at home. Conceptual framework: The framework for the study is based on the assessment and therapeutic interventions components of the Nursing Pain Management Model (Broome & Huth, 2003). Method/participants: In this descriptive study, 68 children undergoing elective tonsillectomy were taught to use the Wong-Baker Pain Scale. Pain intensity scores and data about administration of analgesics were collected from the children, the chart, and parents. Data were collected over 3 days. Results: Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home in spite of significant pain scores of four or five persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of four or five received prescribed morphine only 13% of the time. Conclusions: Children experienced clinically significant pain through the second postoperative day that was not adequately managed by nurses and parents. The large number of children with scores of four or five demonstrates inadequate analgesia through at least the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.
Session #1199 - Pain
The 29th Annual MNRS Research Conference (April 1-4, 2005)