You thought tonsilitis was bad? Having your tonsils removed, now that’s a hard pill to swallow. Very well, you’ll no longer have to fear the CENTOR, but how do we make recovery as pain-free as possible? Pantabtim and colleagues set out to compare nebulised versus intravenous fentanyl for post-tonsillectomy pain in a randomised trial of 59 adults. Tonsillectomy patients received nurse-led care on a postoperative unit where pain was assessed using a numerical pain rating scale of 1–10. Patients with pain scores of ≥4 were given one of the two fentanyl regimens and monitored every five minutes until reaching a score of below 4. The nebuliser cohort had longer lasting pain relief, requiring more analgesia after a median of 6.1 hours compared to 3.9 hours in the intravenous group (p = 0.01). Only 67% of nebuliser patients requested further analgesia whilst 100% of the intravenous patients did (p = 0.003). No differences were seen in time to pain score <4 or in rates of side effects. This study clearly shows that nebulised fentanyl lasts longer and requires less additional analgesia than its intravenous counterpart, which may be useful in a hectic recovery room and for those with tricky intravenous access. However, it misses the mark on the multimodal model endorsed by the PROSPECT guidelines, and excludes key groups including children, elderly, and obese patients. Additionally, the best judges of pain (the patients themselves) are substituted for an unspecified number of nurses using a subjective scale to determine pain relief administration. Despite these issues, I applaud these authors’ efforts for broadening our understanding of postoperative pain relief, but more research is needed. Who knows? Maybe jelly, ice cream, and nebulised fentanyl are just what the doctor ordered.
Tonsillectomies are a pain in the neck!
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