Otolaryngology
Care after Tonsil and Adenoid Surgery with Pain Management
Contents:
Tonsil and Adenoid Surgery Pain Medicine After Surgery Pain Medicine Logs
Please mail completed pain medicine logs to:
Otolaryngology Seattle Children’s PO Box 5371, MS OA.9.321 Seattle, WA 98145
Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the Family Resource Center at 206-987-2201. 7/19 PE1403 © 2019 Seattle Children’s, Seattle, Washington. All rights reserved.
Tonsil and Adenoid Surgery
What are tonsils Tonsils are tissue in the back of the throat and adenoids are higher up, in the and adenoids? back of the nose. While tonsils and adenoids are part of the immune system, removing tonsils (tonsillectomy) and adenoids (adenoidectomy) does not affect the body’s ability to fight infections.
Why are tonsils • For snoring, nasal obstruction or sleep apnea. and adenoids • For frequent tonsil infections. removed? • Adenoids are sometimes removed to reduce sinus and ear infections.
What are the • Bleeding right after surgery, or delayed bleeding up to 14 days after surgery. risks of having Severe bleeding is rare, but can require surgery or a blood transfusion. tonsils and • A permanent voice change is possible, but rare. There is a surgery to correct this. adenoids • Some children may continue to snore or have sleep issues after having their removed? tonsils removed.
How long does it Each child is different. Recovery time for an adenoidectomy usually takes take to recover 2 to 5 days. Recovery time for a tonsillectomy usually takes 7 to 14 days. from surgery?
1 of 3
To Learn More Free Interpreter Services • Otolaryngology • In the hospital, ask your nurse. 206-987-2105 • From outside the hospital, call the • Ask your child’s healthcare provider toll-free Family Interpreting Line, 1-866-583-1527. Tell the interpreter • seattlechildrens.org the name or extension you need.
Tonsil and Adenoid Surgery
How do I care for my child at home?
Pain and Comfort • The pain may be severe and can be worse at night. It is normal for pain to change from day to day. • Take pain medicines as directed by your healthcare provider. Check with your child’s healthcare provider first before giving any type of medicine to your child. • To keep your family safe, store medicines inside a locked cabinet or location where others cannot easily get to them. Once your child has recovered from surgery, dispose of all unused prescription medicines. Taking leftover pain or other medicines on purpose or by accident, can be very dangerous. For more information about safe disposal of unused medications including pain medications, read our handout “How to Get Rid of Unused Prescription Medicines” at seattlechildrens.org/pdf/PE784.pdf or visit takebackyourmeds.org to find a take back place near you.” • Ear pain is very common and normal. It is not a sign of an ear infection. We do not recommend antibiotics for ear pain. • An ice pack placed over the neck is soothing to some children. • Effective pain control will make your child more comfortable, increase activity and strength, and promote healing. Adenoidectomy • Your child may have pain for 2 to 5 days after surgery. Tonsillectomy • Your child may have pain 7 to 14 days after surgery. • Pain may increase on days 5 to 7 after surgery. This is when the scabs in the throat begin to fall off.
Eating and Drinking • Your child may have nausea or vomiting after surgery which should go away by the next day. Give only sips of clear liquids until the vomiting stops. • Liquids are very important! Drinking can reduce pain and help your child heal. Encourage your child to drink plenty of fluids including popsicles, Gatorade, juice, milkshakes, Jell-O, smoothies or ice cream. Milk is fine if it is normally tolerated by your child. • It is safe to drink with a straw. • If your child refuses to drink because of throat pain, make sure they have taken their pain medicine. Then, encourage sips of fluids every 5 minutes for 1 to 2 hours, if needed. • Your child may eat regular food the evening of their surgery. Start with soft foods like soups, pasta, applesauce, yogurt and pudding.
2 of 3 Tonsil and Adenoid Surgery
How do I care for my child at home?
Activity • Encourage quiet play for the first few days after surgery. Adenoidectomy • Plan for your child to be out of school or daycare for 1 to 3 days. • No physical exercise or vigorous activity for 7 days. Tonsillectomy • Plan for your child to be out of school or daycare for at least 1 week. • No gym class, sports or vigorous activities for 2 weeks. • No travel for 2 weeks after surgery.
Bad breath Bad breath is a normal part of the healing process, and will go away in 7 to 10 days after surgery. After a tonsillectomy, the throat will have gray or white patches. These patches are not a sign of infection.
Congestion and After an adenoidectomy, it is common to have increased nasal congestion drainage and drainage. This will usually go away in 7 to 10 days.
Fever A fever up to 102 degrees for several days after surgery is common. We do not recommend antibiotics for fevers. Your child should be seen by their pediatrician if there are other concerning symptoms, including bad cough and working harder to breathe.
Voice changes Your child’s voice may sound different (hypernasal) for several weeks after surgery.
When should I call the doctor?
Call the doctor if • Not urinated in 12 hours your child has: • Refused to drink liquids for 12 hours • A fever of 102 degrees or higher for more than 6 hours that does not go down with acetaminophen or ibuprofen • Severe pain that is not relieved with pain medicine
Take your child to They have bleeding from the mouth or nose, or for vomiting of blood. If the Emergency there is a lot of blood, call 911. Bleeding can occur up to 2 weeks after Department if: surgery.
Who do I call if I For questions, call the Otolaryngology department at 206-987-2105 from have questions? 8 a.m. to 5 p.m. Monday through Friday. For questions after hours, weekends or holidays, call 206-987-2000, and ask the operator to page the on-call Otolaryngology provider.
Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the 7/19 Family Resource Center at 206-987-2201. This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s PE041 needs are unique. Before you act or rely upon this information, please talk with your child’s healthcare provider. © 2019 Seattle Children’s, Seattle, Washington. All rights reserved.
Patient and Family Education | Otolaryngology 3 of 3
Patient and Family Education
Pain Medicine after Surgery (Alternating acetaminophen and ibuprofen, with oxycodone for breakthrough pain)
After a surgery or a procedure, your child may have pain and discomfort. Effective pain control will help your child feel better and heal faster. This handout describes how to safely give your child medicine to relieve pain. We partner with What medicines will help relieve my child’s pain? you and your child There are a number of ways to treat pain. Acetaminophen and ibuprofen to prevent and are common medicines used to treat pain. A stronger medicine, called relieve pain as oxycodone, may be prescribed for breakthrough pain. Breakthrough pain is completely as pain that is not relieved by acetaminophen and ibuprofen. possible. Your child’s healthcare provider has prescribed these medicines:
□ Acetaminophen (Tylenol) □ Ibuprofen (Advil or Motrin) □ Oxycodone □ Other: ______How much medicine do I give my child? The dose may be different for each medicine your child is prescribed. Always read the prescription or label on the medicine container to confirm how much you should give your child. If you did not receive a prescription for Acetaminophen and Ibuprofen, you can follow the Acetaminophen (Tylenol) Dosage Table (seattlechildrens.org/pdf/PE1305.pdf) and Ibuprofen (Motrin or Advil) Dosage Table (seattlechildrens.org/pdf/PE1306.pdf) handouts. How often do I give medicine for pain? It is best to stay on top of your child’s pain by treating it early, rather than waiting for it to get worse. Give your child acetaminophen every 6 hours and ibuprofen every 6 hours. Do not give them at the same time. Alternate the acetaminophen and ibuprofen medicines, so that your child gets one of these medicines every 3 hours. Continue to alternate medicines for the number of days your child’s doctor prescribed. As discomfort or pain improves, you may give your child these medicines less often, or only as needed. Use the Pain Medicine log on page 4 to keep track of when you, and other care givers, give your child pain medicines. Should I wake my child to give them pain medicine? If your child is resting comfortably, you do not need to wake your child to give pain medicines. But, if they wake with a lot of pain, you may want to wake them the next night to give them a dose. When possible, give your child a dose right before they go to sleep.
1 of 6 Pain Medicine after Surgery
Does my child need to eat with pain medicine? You can give your child acetaminophen without food (on an empty stomach). Ibuprofen and oxycodone should be given with some food. What if acetaminophen and ibuprofen do not relieve my child’s pain? Sometimes alternating doses of acetaminophen and ibuprofen do not provide enough pain relief. For moderate to severe breakthrough pain, your child may be prescribed a stronger type of pain medicine called oxycodone. Use the scale below to assess the amount of pain your child is having. If the number of “yes” responses is 6 or more, your child is having pain that should be treated with oxycodone. You can give the oxycodone as needed along with the alternating doses of acetaminophen and ibuprofen. Wait at least 4 hours between doses of oxycodone. If your child needs more than 2 to 3 doses in a 24 hour period, contact your surgeon for guidance. Oxycodone may cause stomach pain or nausea. If you think that your child’s discomfort might be from the oxycodone, contact your doctor for other options. Pain after Surgery Measure Below is a list of behaviors your child may or may not have after a surgery or procedure. Watch your child’s behavior for a period of time, for example, between breakfast and lunch or lunch and dinner. If you answer “yes” to 6 or more questions, your child is having pain that should be treated with oxycodone. Between ______and ______today did your child: • Whine or complain more than usual? Yes No • Cry more easily than usual? Yes No • Play less than usual? Yes No • Not do the things they normally do? Yes No • Act worried more than usual? Yes No • Act more quiet than usual? Yes No • Have less energy than usual? Yes No • Refuse to eat? Yes No • Eat less than usual? Yes No • Hold the sore part of their body? Yes No • Try not to bump the sore part of their body? Yes No • Groan or moan more than usual? Yes No • Look more flushed than usual? Yes No • Want to be close to you more than usual? Yes No • Take medicine when they normally refuse? Yes No
Information from: Chambers, C.T., Reid, G.J., McGrath, P.J., & Finley, G.A. (1996). Development and preliminary validation of a postoperative pain measure for parents. Pain, 68, 307-313.
2 of 6 Pain Medicine after Surgery
Questions? To Learn More We are committed to partnering with you and your child to prevent and • Your child’s surgery relieve your child’s pain. Some discomfort following a procedure or surgery clinic is expected. If you are worried that your child’s pain is too severe, contact • Ask your healthcare your care team at any time. provider • seattlechildrens.org
Free Interpreter Services
• In the hospital, ask your child’s nurse.
• From outside the hospital, call the toll-free Family Interpreting Line 1-866-583-1527. Tell the interpreter the name or extension you need.
Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the Family Resource Center at 206-987-2201. 7/19 This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique. Before you act or PE1251 rely upon this information, please talk with your child’s healthcare provider. © 2019 Seattle Children’s, Seattle, Washington. All rights reserved.
Otolaryngology 3 of 6 Pain Medicine after Surgery
4 of 6 Pain Medicine after Surgery
Pain Medicine Log Child’s Name ______Surgery Date ______Instructions: • Give one medicine dose every 3 hours, alternating between acetaminophen and ibuprofen. • Give oxycodone as needed for breakthrough pain, pain that is not relieved by acetaminophen and ibuprofen. Wait at least 4 hours between doses of oxycodone. • Your child should follow this medicine schedule for the number of days their doctor prescribed. • Record each medicine at the time you give it.
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Oxycodone - Give Alternate Acetaminophen and Ibuprofen Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am x 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am x 10 am 10 am 10 am
11 am 11 am x 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm x 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm x 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm x 7 pm 7 pm 7 pm
8 pm 8 pm x 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm x 10 pm 10 pm 10 pm
11 pm (sleeping) 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
5 of 6 Pain Medicine after Surgery
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Oxycodone - Give Alternate Acetaminophen and Ibuprofen Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
6 of 6
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Alternate Acetaminophen and Ibuprofen Oxycodone - Give Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Alternate Acetaminophen and Ibuprofen Oxycodone - Give Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Alternate Acetaminophen and Ibuprofen Oxycodone - Give Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Alternate Acetaminophen and Ibuprofen Oxycodone - Give Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Alternate Acetaminophen and Ibuprofen Oxycodone - Give Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am
Pain Medicine Log
Day of the week: Day of the week:
Alternate Acetaminophen and Ibuprofen Alternate Acetaminophen and Ibuprofen Oxycodone - Give Oxycodone - Give as needed. Wait at as needed. Wait at Acetaminophen Ibuprofen least 4 hours Acetaminophen Ibuprofen least 4 hours Give every 6 Give every 6 between doses Give every 6 Give every 6 between doses hours hours hours hours Time Time Given Time Given Time Time Given Time Time Given Time Given Time Time Given
6 am 6 am 6 am 6 am
7 am 7 am 7 am 7 am
8 am 8 am 8 am 8 am
9 am 9 am 9 am 9 am
10 am 10 am 10 am 10 am
11 am 11 am 11 am 11 am
12 pm 12 pm 12 pm 12 pm
1 pm 1 pm 1 pm 1 pm
2 pm 2 pm 2 pm 2 pm
3 pm 3 pm 3 pm 3 pm
4 pm 4 pm 4 pm 4 pm
5 pm 5 pm 5 pm 5 pm
6 pm 6 pm 6 pm 6 pm
7 pm 7 pm 7 pm 7 pm
8 pm 8 pm 8 pm 8 pm
9 pm 9 pm 9 pm 9 pm
10 pm 10 pm 10 pm 10 pm
11 pm 11 pm 11 pm 11 pm
12 am 12 am 12 am 12 am
1 am 1 am 1 am 1 am
2 am 2 am 2 am 2 am
3 am 3 am 3 am 3 am
4 am 4 am 4 am 4 am
5 am 5 am 5 am 5 am