Current post-tonsillectomy analgesia practices among Australian and New Zealand anesthetists, and opinions on non-opioid alternatives

Abstract

Introduction

Children experience significant pain following extracapsular tonsillectomy surgery, and while opioids are often prescribed to treat this, clinicians may be wary of their adverse side effects, leading to variation in practice. There is a need for improved post-tonsillectomy pain management in children. To plan clinical trials into alternative analgesia, it is important to understand clinician opinions on post-tonsillectomy pain and its management, including the difference in pain scores that would convince them to begin prescribing alternative analgesia.

Methods

Anesthetists in Australia and New Zealand were surveyed on their expectations of children’s pain five-days post tonsillectomy. They were asked about their analgesic drug prescribing practices for these patients, as well as their expectations of the efficacy of three non-opioid treatments (clonidine, gabapentin, and honey).

Results

Responses from 109 anesthetists practicing pediatrics with experience ranging from <5 years to >20 years revealed variation in opinions on post-tonsillectomy opioid requirements and prescribing practices. 44% of respondents believed that “most children” should be prescribed opioids to manage their post-tonsillectomy pain, while 16% believed that no children should. On average, a pain decrease of 2-points on day five “might” convince respondents to change their practice to include clonidine, gabapentin or honey in their post-tonsillectomy analgesia regimen.

Discussion

These results reveal the variation in practice in pediatric post-tonsillectomy analgesia prescribing by Australian and New Zealand anesthetists. They can provide guidance when planning clinical trials into non-opioid treatments of post-tonsillectomy pain and understanding into the variation in practice among anesthetists in post-tonsillectomy pain management.