PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
GoRs are assigned according to the overall LoE on which the recommendations are based, which is determined by the quality and source of evidence: Relationship between quality and source of evidence, levels of evidence and grades of recommendation.
Tonsillectomy is one of the most frequently performed surgical procedures and pain management remains challenging. It has been identified as one of the most painful surgical procedures (Gerbershagen 2013), probably because pain remains poorly managed in clinical practice (Gerbershagen 2013; Maier 2010; Persino 2017). Tonsillectomy is unique for several reasons including the type of tissue trauma; the exposure of the healing wound to movement of the pharynx during ingestion; the risk of bleeding and limitations in the choice of drugs, particularly in children.
The aim of this procedure-specific guideline is to provide clinicians with up-to-date evidence for optimal pain management in tonsillectomy, and recommendations made based on this evidence, adverse effects and considerations regarding risks of interventions.
Although other guidelines for tonsillectomy pain management are available (Ericsson 2015; Paganelli 2014), none have used the PROSPECT methodology to critically evaluate the available literature. This includes a systematic evidence-based approach, the inclusion of a basic analgesic regimen for efficacy evaluation, a balance between efficacy and safety and a Delphi process for the final recommendations with an international group of anaesthetists and surgeons involved.
Unless otherwise stated, ‘pre-operative’ refers to interventions applied before surgical incision and ‘intra-operative’ refers to interventions applied after incision and before wound closure
Analgesics should be administered at the appropriate time (pre- or intra-operatively) to provide sufficient analgesia in the early recovery period
Unless otherwise stated, ‘postoperative’ refers to interventions applied at or after wound closure
Analgesic interventions that are not recommended for pain management in patients undergoing tonsillectomy.
Overall recommendations for pain management in patients undergoing tonsillectomy.
PROSPECT recommendations for tonsillectomy – infographic
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