Audit of peri-operative pain management in paediatric patients following tonsillectomy at a tertiary hospital in Johannesburg
Date
2017
Authors
Mogane, Palesa Nomusa
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Abstract
Background
Adeno-tonsillectomy remains one of the most frequently performed surgical procedures in children. Despite improvements in anaesthetic and surgical techniques, severe pain is reported in as many as 25 – 50 % of children. Pain assessment and knowledge of drug pharmacodynamics and pharmacokinetics in the paediatric patient, is a prerequisite for optimal care. Much has been written on peri-operative pain management following tonsillectomy. However, no consensus has been reached on what the ideal analgesic regime should be. This audit is a review of current practice at Chris Hani Baragwanath Academic Hospital. It aims to identify problems and develop possible solutions to improve anaesthetic practice.
Methods
A prospective, contextual, descriptive study design using a data collection sheet was used on paediatrics patients presenting for tonsillectomy.
Results
Eighty five patients aged three to 12 years of age, with ASA grading I or II were enrolled in the study. The choice of anaesthetic was variable with a combination of simple analgesics, opioids and adjuvants. This affected postoperative pain scores. Snare dissection and monopolar cautery haemostasis, was the standard surgical technique. Surgical seniority influenced the duration of tonsillectomy, with an effect on postoperative pain scores.
Conclusions
Audits are necessary to evaluate what resources are needed to optimise care. The occurrence of pain after tonsillectomy continues to be poorly managed. Appropriate premedication and no more than two hours of starvation (after clear liquid ingestion) needs to be introduced. Where possible surgical technique should involve bipolar cautery and be limited to less than 45 minutes. A preemptive, multimodal, opioid-sparing anaesthetic should be routinely practiced.
Description
A research report submitted to the faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfilment of the requirements for the
degree of Master of Science in Medicine in Anaesthesiology
Johannesburg, 2017.