Behandling av smärta och illamående i samband med tonsilloperation. Nya riktlinjer för farmakologisk behandling till barn och ungdomar
Engelsk titel: Treatment of pain and nausea associated with tonsil surgery. New guidelines for the pharmacological treatment of children and adolescents
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Författare:
Brattwall, Metha
;
Lundeberg, Stefan
;
Ericsson, Elisabeth
Email: metha.brattwall@vgregion.se
Språk: Swe
Antal referenser: 31
Dokumenttyp:
Översikt
UI-nummer: 14117451
Sammanfattning
Surgery of the tonsils can lead to severe pain lasting for many days, which has been shown by data from the National Tonsil Surgery Register in Sweden. Tonsillotomy
gives fewer readmissions due to bleeding, number of days using analgesics and health care contacts due to pain compared to tonsillectomy. The register data demonstrate the
necessity of better-evidenced based pain treatment guidelines for tonsil surgery. Premedication is the start of the multimodal pain approach and includes oral paracetamol
(acetaminophen), clonidine and betamethasone. Alternatively the combination can be administered i.v. in the early peroperative phase. At the end of surgery, if no bleeding
problems, coxibs can be given. After discharge from hospital, the recommendations for pain relief are paracetamol combined with COX inhibitors (ibuprofen and diclofenac) and
if needed oral clonidine in favor of opioids. When pain intensity decreases, discontinue the analgesic treatment in the following order: opioid, clonidine, paracetamol and at last
ibuprofen. The need for analgesic treatment after tonsillectomy is usually 5-8 days, and after tonsillotomy 3-5 days. Parents are recommended to contact the hospital if the child
has difficulties to drink or eat adequately postoperatively and suffers from pain despite taking the recommended medication regularly.