@article{JOMA8001,
author = {Elizabeth A. Ghazal and Patrick D. Leiter and Stacy J. Youn and Richard L. Applegate},
title = {A narrative review of pediatric tonsillectomy and adenoidectomy pain management: evidence-based strategies and emerging trends},
journal = {Journal of Oral and Maxillofacial Anesthesia},
volume = {5},
number = {0},
year = {2026},
keywords = {},
abstract = {Background and Objective: Pediatric tonsillectomy, with or without adenoidectomy, is commonly performed with >500,000 cases in the USA annually and is most often performed for sleep disordered breathing, obstructive sleep apnea (OSA) or recurrent infection. Post tonsillectomy pain is common, often severe, can last for days. Sequelae may lead to increased resource utilization and costs. Evidence regarding opioid sensitivity in patients with OSA, reports of death or neurologic injury after tonsillectomy, increasing rates of opioid dependence and rising numbers of opioid-related deaths prompted development and introduction of guidelines and enhanced recovery pathways promoting multimodal, opioid sparing or avoiding, analgesic regimens for these patients. This narrative review aims to provide clinically relevant guidance to inform analgesic choices for children undergoing tonsillectomy and adenoidectomy.Methods: A comprehensive literature search was conducted by the authors for publications from March 1993 to March 2026 in PubMed and the Cochrane Library, augmented using an AI search tool. The search terms were “analgesia after pediatric tonsillectomy AND opioid”, “pediatric tonsillectomy AND opioid free”, “pediatric tonsillectomy AND analgesia guidelines”, “pediatric obstructive sleep apnea AND opioid sensitivity”, “clinical practice guidelines pediatric tonsillectomy” and review of standard pediatric anesthesiology textbooks for additional references. Inclusion criteria were English-language manuscripts, pediatric tonsillectomy with or without adenoidectomy, perioperative care of children, society guidelines, and discussion of indications and risk factors. Publications were summarized by the authors to develop a narrative review of perioperative considerations, impacts of surgical techniques on postoperative pain, and optimized patient-centric approaches to analgesia in children undergoing these procedures.Key Content and Findings: Current clinical guidelines support the use of acetaminophen, nonsteroidal anti-inflammatory drugs, and a single intraoperative dose of an intravenous corticosteroid for pain management. Additional strategies, such as intraoperative administration of low-dose opioids, dexmedetomidine or ketamine, may be considered. Local anesthetic infiltration has been shown to decrease pain scores in the early recovery period, but further analysis is needed on additional analgesic requirements in these patients.Conclusions: This narrative review highlights evidence that nonopioid strategies can minimize and treat pain in children undergoing tonsillectomy and adenoidectomy. Using nonopioid analgesics avoids opioid induced respiratory depression risks.},
issn = {2790-8852}, url = {https://joma.amegroups.org/article/view/8001}
}