Audit of pain management at home following tonsillectomy in children

The pain experienced at home and the burden this places on primary care res ources is considerable following tonsillectomy in children. This was audite d by postal questionnaire in 52 patients (36 responders). We found a signif icant proportion of patients experiencing moderately severe to severe pain and a high rate of consultation with general practitioners (50 per cent) fo r pain-related issues. These findings lead to changes in practice which inc luded the provision of five days discharge medication (paracetamol/ibuprofe n in non-asthmatics; paracetamol/dihydrocodeine in asthmatics) and improved written discharge advice. On re-auditing a year later in 100 patients (56 responders), we found reduced rates of consultation with general practition ers (27 per cent). However, the proportion of children experiencing moderat ely severe to severe pain was not reduced probably because most children we re given the recommended analgesia during the first audit. We also found th at paracetamol and ibuprofen was superior to paracetamol and dihydrocodeine for analgesia (p<0.05). Suggestions for further improvements are discussed .