AAO-HNS Member Expert Q & A – Post-Tonsillectomy/Adenoidectomy Pain Management
Expert Q&A on how parents can help manage pain after their child has a tonsillectomy/adenoidectomy with Anna Messner, MD, Professor & Vice Chair, Department of Otolaryngology-Head & Neck Surgery, Stanford University, and David E. Tunkel, MD, Chair of the AAO-HNS Pediatric Otolaryngology Committee, and Director, Pediatric Otolaryngology, Johns Hopkins Hospital
Q. What pain medicines are commonly recommended after tonsillectomy/adenoidectomy?
A. During the procedure and in the recovery room your child will be given pain medication through an intravenous (IV) line. In addition, an acetaminophen suppository [like Tylenol®] will often be given at the time of the surgery. After surgery, younger children (age 3 years and younger) are most commonly treated with acetaminophen. Acetaminophen can be given every four hours as either an oral liquid or rectal suppository. Some physicians recommend ibuprofen [like Advil ®] after a tonsillectomy. Ibuprofen provides excellent pain control and has not been shown to increase the risk of postoperative bleeding. 1 While acetaminophen with codeine is commonly used for pain control after tonsillectomy in children, this combination of medications has not been shown to be more effective than either acetaminophen or ibuprofen alone.2,3 It has been recently reported that children may have side effects from the codeine, due to differences in the way the medicine is processed by the body. Narcotic pain medicine (such as codeine) should be used with special precautions in children who have obstructive sleep apnea. Talk with your physician about any pain medication they may prescribe for your child to understand all of the possible side effects.
Q. Can I give my child aspirin after a tonsillectomy?
A. Children and teenagers should not be given aspirin after a tonsillectomy due to the increased risk of bleeding from the surgical site.8 The anti-clotting effects of aspirin last for days, so aspirin should not be given for 10 days before tonsillectomy as well. In addition, aspirin is associated with Reye's syndrome in children (an extremely rare but serious illness that can affect the brain and liver), so should not be given without a specific recommendation from a physician.
Q. Should I give my child pain medicine as soon as it is time, or should I wait until my child complains of pain?
A. When you leave the hospital, the staff in the recovery room should tell you when your child may receive the next dose of pain medication at home. It is a good idea to keep a pain medication log so you know exactly when you can give the medication. In general, it is recommended that pain medication be given at regular intervals around the clock for the first few days following surgery and as needed after that time.9 Studies have shown that children have a severe sore throat after tonsil surgery, and so often they are not given all the doses of medication that are recommended.10 We recommend giving the medication on time, and at regular intervals, even waking your child up at night to give the medicine.
Q. My child refuses to eat or drink anything - including the pain medicine. What can I do?
1) Consider an alternative route for the pain medicine: Acetaminophen is available in rectal suppository form and a prescription is not needed. It is available in four doses: 80mg, 120mg, 325 mg, and 650mg. The appropriate dose can be determined by your child's weight.
2) Many children respond to an incentive system. Try giving your child fluid of your choice in a small medicine cup. With each cup of fluid swallowed, reward the child with an "x" or sticker on a chart. Set a goal with your child regarding the number of "x's" and reward him or her when the goal is met (for example, if he drinks 10 cups of liquid, he will receive a prize).
Q. After surgery, should I give my child medication to prevent him/her from vomiting?
A. Routine use of medication to prevent vomiting after surgery is not recommended. If your child feels nauseated, or is vomiting, let him or her rest and sleep. Usually the vomiting stops after the anesthesia has had time to wear off. Do not push your child to drink or eat if his stomach is upset. Consider giving an acetaminophen suppository for pain control until the nausea improves. Contact your surgeon if the nausea persists for more than 24 hours. Promethazine (Phenergan), an anti-nausea medication frequently given to adults, should not be used in children under 2 years of age or in any child with obstructive sleep apnea.12
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