Pain Control after Tonsillectomy: A Survey of Membership of the American Society of Pediatric Otolaryngologists

Abstract

Objectives:

(1) Describe current prescribing practices and opinions of membership of the American Society of Pediatric Otolaryngologists (ASPO) regarding analgesia after pediatric adenotonsillectomy. (2) Understand prevailing opinions about opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) that influence medication selection in this setting.

Methods:

Pain management after pediatric adenotonsillectomy is controversial. We conducted a web-based survey of ASPO membership to understand current post-adenotonsillectomy prescribing practices, with emphasis on attitudes regarding opioids and NSAIDs.

Results:

A total of 110 responses were received. Seventy-eight percent of respondents indicated that they sometimes or always prescribe an opioid as first line analgesic. A majority (74%) indicated they frequently prescribe NSAIDs, while 11% indicated they avoid them entirely. A total of 76% agreed or strongly agreed that opioids increase risk of respiratory events after tonsillectomy, versus 19% in regard to NSAIDs increasing risk of post-tonsillectomy hemorrhage. More than 10 years in practice was associated with increased concern that NSAIDs increase bleeding risk (24% vs 4%, P = .018), but was not associated with increased concerns about opioid-related respiratory suppression. A slight majority (54%) indicated they believed NSAIDs to be either equally or more effective than opioids at controlling pain. Additional areas of inquiry included preferred medications, factors influencing medication choice, respondent confidence in their regimen, and influence of Food and Drug Administration warning on codeine use.

Conclusions:

Significant heterogeneity exists among pediatric otolaryngologists regarding optimal pain management after adenotonsillectomy. Most respondents indicated they frequently prescribe opioids, though most expressed concern about respiratory suppression. We also found broad support for NSAID use among respondents, with comparatively few expressing concern regarding bleeding risk.