National guidelines for pharmacological treatment in children after tonsil-surgery - the implementation and evaluation process

Surgery of the tonsils is still one of the most frequent procedures world wide during childhood. In Sweden thirteen thousand tonsil operations are performed annually. More than 50% are performed in children under the age of 15. Tonsillectomy and tonsillotomy cause severe and extended postoperative pain as well as a high frequency of nausea and vomiting Information from the National Tonsil Surgery Register in Sweden (year 2013) showed that about 26% of patients performed tonsillectomy and 7% of patients performed tonsillotomy were in contact with hospital care due to pain after tonsil surgery. The pain is often most pronounced on day 3 to 5 after tonsillectomy. Tonsillotomy generally gives rise to less pain than tonsillectomy. Dehydration and poor nutritional intake may be a cause of increased pain after tonsillectomies. Older children who underwent tonsil surgery show higher pain scores postoperatively requiring increased need for analgesics. Various interventions including pharmacological are used to treat and prevent pain and nausea. The register data demonstrate the necessity of better-evidenced based pain treatment guidelines for tonsil-surgery. Research can provide valuable answers through clinical guidelines that provide explicit knowledge for improving quality of care in cases of insecurity regarding appropriate practice

Guidelines for pain management were introduced 2013 by the research group in the National Tonsil Surgery Register in Sweden and these guidelines are now implemented at clinics in Sweden. The research project aim to follow up several aspects of the guidelines: effect on pain management, outcome of different analgesics and factors of importance for successful implementation of new guidelines. The studies in the project have both quantitative and qualitative approach. The researcher have different professional background as Nurse Anesthetist, ENT-physicians Anesthesiologist, Pain-specialist. The research is based on a close collaboration with the reference group for tonsil surgery in the Swedish Tonsil Surgery Register.