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Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team
Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. (CPoN)ORCID iD: 0000-0003-4718-3361
Örebro University, School of Health Sciences. (CPoN)ORCID iD: 0000-0001-7575-6745
Pain Treatment Service, Astrid Lindgren Children's Hospital, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
Örebro University, School of Health Sciences. (CPoN)ORCID iD: 0000-0001-8549-9039
2017 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 101, p. 123-131Article in journal (Refereed) Published
Abstract [en]

Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.

Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.

Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.

Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.

Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 101, p. 123-131
Keywords [en]
Children, Guidelines, Pain Management, Tonsillectomy, Tonsillotomy
National Category
Otorhinolaryngology Pediatrics
Research subject
Caring Sciences w. Medical Focus; Oto-Rhino-Laryngology; Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-59058DOI: 10.1016/j.ijporl.2017.07.040ISI: 000413713100022PubMedID: 28964282Scopus ID: 2-s2.0-85026786151OAI: oai:DiVA.org:oru-59058DiVA, id: diva2:1129886
Projects
Effective postoperative pain management in children after tonsil surgery: barriers and possible solutions
Note

Funding agencies:

Research Committee at Region Örebro County

Örebro University Hospital Research Foundation OLL674631

Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2017-12-05Bibliographically approved

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Alm, FredrikJaensson, MariaEricsson, Elisabeth

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