Parent Pain Management at Home After Tonsillectomy: A Prospective Observational Study in Albert Royer Children's Hospital at Dakar

Introduction: Tonsillectomy is one of the most common interventions in children. The pain secondary to the procedure is intense and long lasting. It is often performed on daily inpatient care, leaving parents and those close to them to provide care at home. We conducted this study to audit pain management at home by parents for kids. Patients and Methods: We conducted a prospective, single-center, qualitative study including families of children aged 0 to 15 years undergoing tonsillectomy or adenotonsillectomy. Pain was assessed before discharge to the PACU and over the telephone on a questionnaire that the parents had to answer. The questionnaire was developed according to the FLACC scale. Home care according to discharge orders was also assessed. Results: A total of 81 patients were collected, including 20 excluded due to call failed. The average age was 7 years (2 –15) with an average weight of 25.9 kg (12 – 72). The female gender was predominant and sex ratio 0.97. Tonsillectomy was indicated for recurrent angina in the majority at 44%. Intraoperative analgesia was administered with paracetamol, ketoprofen or diclofenac, and ketamine. Tonsillectomy was performed with an electrocautery in 77% following a mean operating time of 52.3 min (15 – 90). The discharge FLACC score was less than or equal to 2 in 92% of patients. On the telephone, the complaints collected were pain in 64% of cases, nausea and dizziness in 20% and no complaints in 16%. The last analgesic intake within 6 hours at home was noted in 59% of children mainly with paracetamol only in 85% of cases. The association with an NSAID was noted in 15% of cases. Compliant knowledge of home prescriptions by parents was 56%. The main reason for non-compliance with prescriptions was respect for the patient's sleep. Conclusion: Pain after tonsillectomy is a reality at home. It is taken care of by parents or those around children who do not have the skills necessary for the evaluation and administration of treatments.