Perioperative Pain Relief in Pediatric Tonsillectomy: Current Strategies and Future Directions

Abstract

Highlights: What are the main findings? Post-tonsillectomy pain in children arises from multiple mechanisms including surgical trauma, inflammation, and secondary wound healing, and follows a characteristic biphasic course. The most effective management strategy is a multimodal analgesic regimen combining acetaminophen, NSAIDs, and perioperative dexamethasone, supported by local anesthetic techniques and complementary home-based measures. Careful selection and timing of analgesics significantly reduce pain intensity, limit opioid use, and improve early oral intake and recovery. What is the implication of the main finding? Implementing an individualized multimodal approach promotes safer opioid-sparing pain control and enhances recovery after pediatric tonsillectomy. Understanding pain mechanisms and pharmacologic interactions enables clinicians to tailor treatment, prevent complications, and reduce hospital readmissions. Postoperative pain following pediatric tonsillectomy remains a significant clinical challenge. Inadequate management leads to delayed recovery, dehydration, and increased healthcare utilization. Multimodal analgesia, including combining systemic analgesics, local anesthetic techniques, and adjunctive medications, has emerged as the standard of care. This review highlights current perioperative pain management strategies, including recent evidence on multimodal and opioid-sparing approaches. Local infiltration and nerve blocks provide site-specific pain relief, reducing opioid requirements and improving patient comfort. A comprehensive understanding and careful selection of analgesic regimens are crucial for enhancing outcomes in this population.