Patterns of pain and analgesic use in 3- to 7-year-old children after tonsillectomy

Pain Manag Nurs. 2006 Dec;7(4):159-66. doi: 10.1016/j.pmn.2006.09.005.


Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. As part of a larger study, 68 children undergoing tonsillectomy were taught to use the Wong-Baker FACES Pain Rating Scale. Pain intensity scores and data about administration of analgesics were collected from children, the medical record, and the parents over a 3-day period. Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home despite significant pain scores of 4 or 5 persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesia / methods
  • Analgesia / psychology
  • Analgesics / therapeutic use*
  • Attitude to Health*
  • Child
  • Child, Preschool
  • Drug Administration Schedule
  • Female
  • Health Services Needs and Demand
  • Home Nursing / education
  • Home Nursing / methods
  • Home Nursing / psychology
  • Humans
  • Iceland
  • Male
  • Nursing Evaluation Research
  • Nursing Methodology Research
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / epidemiology*
  • Pain, Postoperative / etiology
  • Parents / education
  • Parents / psychology*
  • Patient Discharge
  • Postoperative Care / methods
  • Postoperative Care / nursing
  • Postoperative Care / psychology
  • Severity of Illness Index
  • Tonsillectomy / adverse effects*
  • Treatment Outcome


  • Analgesics