ORCID Identifier(s)

0000-0003-0586-832X

Graduation Semester and Year

2016

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Lauri D John

Abstract

There has been little research on pain outcomes in obese and overweight (OB/OW) children undergoing surgery. Tonsillectomy or adenotonsillectomy (T&A) is one of the most common painful surgeries performed in children. The estimated number of OB/OW children undergoing T&A each year approaches 200,000. Post-tonsillectomy pain (PTP) management after surgery is complicated by potential for airway obstruction or altered drug metabolism in OB/OW children. The purpose of this study was to examine associations between weight status and PTP outcomes in the PACU. A retrospective correlational cohort design was used. Data were obtained from 180 electronic health records of children who had T&A or tonsillectomy in 2016 at a pediatric medical center in north Texas. Weight status did not significantly increase the odds of experiencing early PTP (adjusted OR = 1.391, p = 0.369). OB/OW status was associated with significantly longer episodes of uncontrolled PTP (rs(178) = 0.16, p = 0.03). This is the first research report indicating that weight status in children may be associated with increased sustained pain across time. Based on these findings, it is recommended that clinicians consider greater use of non-opioid medications and soothing factors to lower pain. Education of clinicians should include content about increased risk for uncontrolled PTP, drug metabolism in OB/OW individuals, and alternative methods to reduce pain. Future research is needed to determine if there are other factors such as severity of obstructive sleep apnea or genetic identifiers that could predict risk for uncontrolled PTP. Research-based guidelines for adjusted drug calculations in OB/OW children undergoing T&A are needed. Development of pain assessment tools with increased sensitivity and practical application in the PACU could improve the ability to detect differences in pain outcomes of children. Clinically relevant screening tools could be helpful in assessment of OB/OW children for pain-related risks when undergoing T&A.

Keywords

Obese, Tonsillectomy, Pain, Post-tonsillectomy pain, Pain management, Pediatric surgery, Post anesthesia, Postoperative

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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